Pediatric Annals

Language Disorders in Childhood and Adolescence: Implications for Learning and Socialization

Anthony S Bashir, PHD; Elisabeth H Wiig, PHD; Jules C Abrams, PHD

Abstract

"And then when there is no more and then when it's gone and then we can have some Lmore." This is what R.J. said to his mother when he was 8 years old. He was trying to explain to her that when he finished one activity he wanted to try another one. His mother responded with confusion. She and R.J. spent time trying to understand what R.J. meant and intended to say; each experienced frustration.

Language is used as the principal means of presenting information to others, asking others for information, sharing feelings, attitudes and beliefs, and controlling the environment. For R.J. and his mother this process of communication was not always effective or pleasurable. Their situation exemplifies the frustrations experienced by children with language disorders and by their families.

The past decade has seen an increasing body of research which focuses on language acquisition in childhood and linguistic transitions during adolescence. The presence of language disorders during the preschool years has significant implications for later school learning and social adaptation. 1-3-14 "Language disorders" is a term that represents a group of different developmental disorders, characterized by deficits or alterations in the comprehension, production and/or interpersonal use of language. These disorders are chronic; the symptoms, manifestations, and effects change over time and at various stages of development. The deficits affect the way in which the individual understands what is said, speaks, and processes spoken language, as well as stores, retrieves and accesses verbal information. Individuals with language disorders also may demonstrate changes in cognitive style and organization.4'9 The years from age 9 to 15 or 16 are of equal significance to the preschool years in linguistic attainments. Previously, there was an erroneous assumption that "adult competence in language" was acquired by age 5 or 6 years.4

SOME FEATURES OF DEVELOPMENTAL LANGUAGE DISORDERS

During the preschool years, children present with various disorders of communication that may be associated with different medical, psychiatric, and developmental disabilities. Among these communication deficits are disorders of language. Parents voice their concerns for the appropriateness of the child's communication development by the second year of life. They are concerned that the child does not attend well to activities or listen to stories for long periods of time. Parents note that the child does not seem to always understand what is said, does not comply with requests, or follow directions. It is often difficult for the parent to understand the child's speech, grasp the meaning of what the child is saying, or know what the child intends. From the beginning, disruptions in communication affect the child and ease of interaction within the family structure.

Children at high risk for later academic learning deficits present with three major types of speech and language disorders. These are (a) problems of comprehending spoken and written language, (b) problems of oral and written language production, as welt as deficits in the use of language for social interaction, and (c) articulation disorders that reflect motor planning problems. Similar problems in language and motor planning are noted to constitute major subtypes of the learning disabilities.10,11

In the development of curriculum, the assumption is made that a child has knowledge of language and knows how to apply this knowledge for learning new skills and information. In the case of children with language disorders this presupposition is not valid. Consequently, the child is at high risk for academic failure of varying degrees and types. The presence of a language disorder in a child poses multiple problems in the educational process. This is true because language is "both curriculum content and learning environment, both the object…

"And then when there is no more and then when it's gone and then we can have some Lmore." This is what R.J. said to his mother when he was 8 years old. He was trying to explain to her that when he finished one activity he wanted to try another one. His mother responded with confusion. She and R.J. spent time trying to understand what R.J. meant and intended to say; each experienced frustration.

Language is used as the principal means of presenting information to others, asking others for information, sharing feelings, attitudes and beliefs, and controlling the environment. For R.J. and his mother this process of communication was not always effective or pleasurable. Their situation exemplifies the frustrations experienced by children with language disorders and by their families.

The past decade has seen an increasing body of research which focuses on language acquisition in childhood and linguistic transitions during adolescence. The presence of language disorders during the preschool years has significant implications for later school learning and social adaptation. 1-3-14 "Language disorders" is a term that represents a group of different developmental disorders, characterized by deficits or alterations in the comprehension, production and/or interpersonal use of language. These disorders are chronic; the symptoms, manifestations, and effects change over time and at various stages of development. The deficits affect the way in which the individual understands what is said, speaks, and processes spoken language, as well as stores, retrieves and accesses verbal information. Individuals with language disorders also may demonstrate changes in cognitive style and organization.4'9 The years from age 9 to 15 or 16 are of equal significance to the preschool years in linguistic attainments. Previously, there was an erroneous assumption that "adult competence in language" was acquired by age 5 or 6 years.4

SOME FEATURES OF DEVELOPMENTAL LANGUAGE DISORDERS

During the preschool years, children present with various disorders of communication that may be associated with different medical, psychiatric, and developmental disabilities. Among these communication deficits are disorders of language. Parents voice their concerns for the appropriateness of the child's communication development by the second year of life. They are concerned that the child does not attend well to activities or listen to stories for long periods of time. Parents note that the child does not seem to always understand what is said, does not comply with requests, or follow directions. It is often difficult for the parent to understand the child's speech, grasp the meaning of what the child is saying, or know what the child intends. From the beginning, disruptions in communication affect the child and ease of interaction within the family structure.

Children at high risk for later academic learning deficits present with three major types of speech and language disorders. These are (a) problems of comprehending spoken and written language, (b) problems of oral and written language production, as welt as deficits in the use of language for social interaction, and (c) articulation disorders that reflect motor planning problems. Similar problems in language and motor planning are noted to constitute major subtypes of the learning disabilities.10,11

In the development of curriculum, the assumption is made that a child has knowledge of language and knows how to apply this knowledge for learning new skills and information. In the case of children with language disorders this presupposition is not valid. Consequently, the child is at high risk for academic failure of varying degrees and types. The presence of a language disorder in a child poses multiple problems in the educational process. This is true because language is "both curriculum content and learning environment, both the object of knowledge and a medium through which other knowledge is acquired."12

PROBLEMS IN COMPREHENSION OF LANGUAGE

Comprehension refers to an individual's ability to derive meaning from spoken and written messages. The act of understanding is complex and accuracy of comprehension results from deriving meaning from words, the relationships specified by words, sentence structures, and larger texts, whether oral or written discourse. Individuals must also share experiences, contexts, and knowledge if comprehension is to be accurate and efficient. Finally, adequate comprehension depends upon reasoning abilities as well as judgments concerning communication intents.13

Upon examination, children with comprehension problems present with a variety of findings. Specific linguistic skills, required for comprehension, are often delayed in acquisition. For example, the child may understand single words such as "cup" or "cookie," but be unable to understand the request, "Where is your cup?" or the assertion, "The cookie is in the box. " Still other children may have problems in comprehending the intention of messages such as requests for action or statements about feelings and attitudes. For example, as the child leaves the house, the mother states, "Your face is dirty." The child does not interpret this as a directive to clean his face. The mother, noting the lack of response on the part of the child, interprets it as disobethence and an altercation and struggle ensues. Other deficits in comprehension may occur through the misinterpretation of specific adjectives, time markers, references to locations, commonly used idiomatic expressions, and humor. The child may be able to understand simple sentences, but not be able to comprehend the same meaning when expressed in a conversation. Frequently, they are not perceived as active and rewarding conversational partners or potential playmates for their peers.

As children get older and advance in school, other problems in comprehension emerge and assume significance. These problems include inability to understand specific core vocabularies within the curriculum, for example, science and social studies. The pre-adolescent and adolescent also experience problems with higher order semantic relationships and intents. As examples, they may not understand figurative expressions, jokes, or sarcasm. In addition, they have difficulties in using language to draw inferences and conclusions. Because learning becomes increasingly dependent on lecture formats and read texts, children with problems of comprehension are inefficient and inaccurate in acquiring new information. At the higher grade levels, the presence of reading disabilities significantly interferes with continued learning of vocabulary, narrative content, and production of written formats.

PROBLEMS IN ORAL LANGUAGE PRODUCTION AND USE

A major accomplishment of the childhood years is the ability to produce language for representing intentions and meanings. During the early years, children with oral language production problems may have a limited expressive vocabulary, a reduction in the ability to specify relationships among actions, events, objects, or people, and problems in building sentences that allow for the expression of complex ideas. These children also may have difficulty finding the exact words which best represent their meaning and intention. A child may express perfectly valid ideas in such a manner that they are not readily understood by the listener. An example occurred when a 5-year-old boy tried to tell his friend about a cartoon show. He said, "That's cartoon show . . . about bad guys in a ship and on the Argo (pause), and they got away motion gun (pause). This thing gesturing ray gun), this thing here goes clicked up really fast . . . when they fire it. " This example illustrates the problems the child may have in accuracy of word use, retrieval of specific content words, automatic application of sentence production rules, and in organization and maintenance of topic focus.

As children advance in school, they are required to produce oral and written explanations, descriptions, and reports. Children with language disorders typically have difficulty in producing oral explanations and descriptions in such a way that a listener can appreciate the topic, the organization of events, and the intended purpose of the verbal interaction. As an example, a 9'vear-old girl was requested by her teacher to explain to the class how to play a game of baseball. She responded, "Well . . . you have to pitch the ball and you have to hit it and if you . . . sometimes you get four balls and you walk to first base and then you get a hit like a home run. You have to hold the ball to see if the man is on which base and the persons gonna try to run from the base will run to first, second, third, home . . . and that's it. "

The implications of problems in language production for educational interactions are obvious. What is less appreciated are the influences on peer and social interactions. Because of their speaking styles, their intentions are often misperceived, resulting in false judgments concerning their mental status. We will comment on this later.

DISORDERS OF SPEECH SOUND PRODUCTION

Disorders of articulation are heard as deviations in the production of speech sounds. There are many causes of articulation disorders. One specific group of disorders results from a disruption in the child's ability to voluntarily initiate and sequence oral motor movements for purposes of speech sound production. This condition is referred to as oral dyspraxia and may or may not be associated with other forms of body apraxia. Initially these children may have a limited sound production repertoire and rely on gestures for communication with and control of their environments. They respond well to treatment, but by late childhood and adolescence may show problems in production of multisyllabic words, complex blends, and of intonation patterns. The exact ways in which these motor disorders are associated with learning disabilities are not well -documented. Clinical experience suggests that these children may also have subtle problems in oral language formulation and additional visual-motor coordination problems, both of which interfere with the production of written text. Additional research is needed to define and clarify the dyspraxia of speech and its association with learning disabilities.

Children whose disorders of communication occur in one or more of the areas noted above are at high risk for academic failure. This is manifested especially in the areas of read and written language. In a study of long-term outcomes, Strominger2 and Aram and Nation14 established that children with preschool disorders of language achieve below grade expectation in reading. No single factor explained the presence of the reading disorder, however. Late sequelae of early language disorders appear to be associated with the complexity of the learning task, the cognitive-conceptual demands, and the application and extension of information.

LANGUAGE DISORDERS AND ACADEMIC ACHIEVEMENT

Students with language and learning disabilities are at risk for academic underachievement. The underachievement is often in evidence in the early grades and involves reading, spelling, and writing. Sometimes the pattern of underachievement does not become evident until the upper elementary grades or in junior high or high school. In yet other cases, the early pattern of underachievement is reversed by intervention directed toward developing language and basic academic skills. This reversal may be only temporary and may again be in evidence during the junior high and high school years. Halliday comments on this interaction between language and academic achievement as follows15:

Suppose that [language] functions that are relatively stressed [or acquired] by one group are positive with respect to school. They are favored and extended in the educational process, while those that are relatively stressed [or acquired] by another group are largely irrelevant or even negative in the educational context. We have, then, a plausible interpretation of the role of language in educational failure.

The preadolescent and adolescent years are characterized by major shifts in the approach to problem solving.16'20 These shifts are associated with changes in the ability to think about and use language effectively, as well as increasing cognitive-linguistic demands in the traditional curriculum for reasoning and problem solving. Among linguistic attainments indicative of language competence and metalinguistic ability, Menyuk emphasizes four.4 These are:

(1) Increasing knowledge of vocabulary and concepts, awareness of their multiple meanings and uses, and of the semantic relations among and possible combinations of words for expressing thoughts and ideas;

(2) Improved sociolinguistic awareness and knowledge which is reflected in code-switching and perspective taking in speaker-listener interaction.

(3) Increasing ability to relate spoken information to one's own past experiences and internalized knowledge and to make inferences;

(4) Growing awareness of and ability to view "language as object" and to analyze words, phrases, sentences, and intents, all metalinguistic abilities. Grade-related changes in the curriculum require a shift toward language competence and metalinguistic ability to respond to the increasing demands for cognitive, linguistic, social, and emotional maturity.

From time to time, ie, the preschool years, kindergarten through second grade, third to fourth grade, fifth to seventh grade, and the high school years, changes occur in the curriculum, teaching methods, and assumptions about the child as learner. As the individual child or adolescent progresses from grade to grade, it is assumed that the individual will apply, extend, and elaborate previously acquired skills, strategies, and information.1 Given these facts, children with language disorders often fail in the language arts curriculum.

As Cazden has pointed out, language poses serious problems for education.12 The type and degree of problems, the maintenance of language and learning difficulties, and the emergence of new problems across the school years, eg, appreciation of read texts and production of written reports, need to be understood from several points of view. These include: (a) the patterns of cognitive and learning styles of the child; (b) the child's inherent knowledge of language and ability to apply that knowledge for purposes of learning new material; (c) the learning tasks and contexts; (d) the instructional methods; (e) the child's self-concept as learner; and (O the traditional demands for reorganization of abilities demanded by the curriculum as the individual progresses through the grades, eg, the third to fourth grade shift and the movement from junior high school to high school.1

The changes in the curriculum can be summarized as follows.9 The preschool curriculum focuses on language development and social-emotional growth, visual-, auditory-, visual-spatial, and motor skills are taught in a sensorimotor approach. Materials are concrete, manipulative, and three-dimensional. The early grades (K-2) emphasize preoperational cognitive attainments and the development of basic academic skills for reading, writing, spelling, and arithmetic. Teaching materials are now primarily one -dimensional and include pictures and paper and pencil. The content is more abstract with symbolic representations. During the middle years (grades 3-4), basic skills may be reviewed, but are not taught. Instead, content areas such as social studies and science are emphasized. Children are expected to use symbolic and linguistic skills to abstract, analyze and synthesize information, requiring concrete operational cognitive skills.

There is even greater emphasis on content areas in the upper elementary years (grades 5-6). Students are expected to recall information taught earlier and to display fluency and flexibility in using basic academic skills and language. In junior high and high school, the emphasis on formal operational cognitive operations is increased further. Students are expected to listen to lectures, take notes on content, and reorganize information cognitively and linguistically. Foreign languages are introduced, content areas are expanded, and knowledge is generally tested in written language assignments. All of these demands require linguistic competence and metalinguistic ability.

Problems in perspective taking and code-switching, making inferences, interpreting multiple meanings, and interpreting metaphoric expressions (idioms, metaphors, proverbs) can all be explained on the basis of inadequacies in cogniti ve- linguistic strategies, the perspective taken here. In everyday interactions, whether for learning or socialization, these inadequacies can have significant consequences. Language- learning disabled students are often perceived as inflexible or rigid. They often "stick to their guns" in verbal arguments and are hard to sway. They may come across as social "klutzes," because they do not respond appropriately to jokes, ads, sarcasm or metaphoric expressions. They may hurt other people's feelings because they fail to take the other's perspective or modify their behaviors in response to subtle cues or reactions. They often do not make the right inferences in verbal interactions and therefore respond in bizarre fashion. They may exhibit a defensive communication posture which may lead others to infer that they have behavior problems or abnormal affective reactions. Their real feelings and reactions may remain hidden to others. As a result, emotional problems arise and interact with other inadequacies in linguistic and social domains.

LANGUAGE DISORDERS AND SOCIAL AND EMOTIONAL GROWTH

Problems also arise in the area of social interaction and adaptation. Effective communication requires that an active exchange of information occur within a relationship. If the exchange of information is to occur, several behaviors are necessary. These include being able to establish a mutual focus, negotiating exchange of information, ability to express intents according to the prevailing rule system, and to adapt one's own speaking style to the given circumstances and to be able to assume another person's perspective. Effective communication also depends on the accurate understanding and use of non-verbal information such as vocal tone, intonation, and facial and body movements.5,21

By late childhood and early adolescence, the communicatively competent individual should have developed effective communication repertoires. These should allow the individual to:

(1) Present, understand and respond to information in complex spoken or written sentences that relate to persons, objects, events, or processes not immediately visible.

(2) Adapt spoken or written messages to the needs, age, status of conversational partners and the settings in which they occur.

(3) Express positive and negative feelings and reactions to others acceptably and control others through the effective use of language.

(4) Take the role of another person effectively and regard conversation and verbal interactions as a means for self-expression and clarification, as well as being able to plan and respond based on previous experiences and/or observations of others. 22

It is our experience that children with language disorders have not fully acquired these competencies as reflected in their approach to conversations and their behaviors during conversation. Communication occurs with speaker and listener expectations. Early on in a dialogue, the topic of conversation is expected to be established by the initiating speaker. This results in co-orientation of speaker and listeners.

Through communication interchange, the topic of conversation can be clarified, elaborated, or modified by the participants. The child or adolescent with a language disorder may enter a conversation by violating expectations and not introducing the topic fully or early within the conversation. Consequently, the listener is placed in the awkward position of trying to understand the intention of the individual and may, out of frustration, respond to the individual with a variety of reactions, including disbelief, rejection, confusion, and other negative judgments. In turn, the individual begins to incorporate the negative feedback from various conversational partners.

From the outset, the individual becomes concerned about his or her communicative effectiveness and sense of being believed. This results in the development of anticipatory anxiety about oneself and one's acceptability. With more time and more frequent negative experiences, in which there is little or no validation or recognition of the individual's meanings and intents, the individual begins to question and doubt the authenticity of his or her own ideas, wishes, and intentions. By adolescence, many of these children significantly restrict their interactions, assume a passive or defensive communication posture, or develop serious antisocial behaviors.

In recent years, there has been a general recognition of the interaction between learning disabilities, including language disorders, and social and emotional growth and adjustment. This evidence comes from, among others, investigations of communication skills in social interactions, behavior problems, affective disorders, and juvenile delinquency. Bryan and Pflaum and Donahue, Pearl and Bryan observed several negative communication features and postures in children with learning disabilities.23-24 They seem to have general difficulties in interacting with peers and teachers. They do not switch social register or code in their interactions. They are egocentric and do not give sufficient details in their communications. They ate less assertive and effective in conversations than their peers and do not maintain proper control of interactions. These deficiencies are compounded by inadequate vocabulary development, word retrieval, and comprehension and production of syntactic structures.

The behavior disorders associated with learning disabilities were, at one time, viewed to indicate that learning problems reflect emotional problems. The current view is that the emotional problems and learning disabilities must be understood by addressing the interactions among and between environmental stresses and primary vulnerabilities. Thompson gives the following summary of the observed behavioral problems25:

The factor structure of behavior problems in children with educational problems is very similar to that found in other normal and clinical groups: conduct disorder, personality problems, and inadequacy-immaturity. Children with learning disabilities demonstrate higher levels of these behavior problems than do control children but lower levels than children with primary behavior problems.

Cantwell and Carlson concluded that children with language and communication disorders are at high risk for both learning and psychiatric disorders.26 Among incarcerated juvenile delinquents, 89% have been observed to experience significant academic underachievement or learning disabilities.27 Zinkus and Gottlieb suggest that the problems they observed in academic achievement among juvenile delinquents were more closely linked to perceptual disorders and processing deficits than to delinquency, per se.28 WoIfF et al, in a study comparing the neurological, linguistic, psychomotor, and cognitive functions of adolescent boys detained for antisocial behaviors and of nondelinquent controls, concluded that the "delinquent group were selectively impaired in language functions and that the language deficits were a characteristic of the delinquent index group rather than a non-specific correlate of social environmental factors."29 With these observations as a background, success in the linguistic transitions during adolescence seems more important. If the transition does not occur spontaneously, as suggested, language assessment and intervention are indicated.

There are certain features in the linguistic performances of adolescents with language-learning disabilities that stand out in behavioral as well as in formal, standardized observations. One set relates to response timing. Responses are often (1) immediate and give little time for reflecting before responding, indicating an impulsive style, or (2) significantly delayed (30 seconds or more), indicating a need for increased processing time, inefficient processing, problem-solving and/or planning processes. Either of these features suggests deficits in linguistic competence or performance.

A second set of observations relate to specific levels of processing linguistic stimuli. First, the process of targeting the significant features in the message or content is often inadequate. The wrong words or phrases are often targeted as significant in multiple meaning sentences, jokes, sarcasm, ot metaphoric expressions. This leads to erroneous or partial conclusions and responses. Secondly, there is a tendency to generate only one hypothesis or alternative in response to a linguistic message and the contexts. While this tendency works well when skills are called for, it is inadequate in situations where there are several response options or alternatives. Selection of the best alternative is a function of accuracy of social perception. The individual tends to choose a restricted response, leading to a single course of action, not always the most efficient or appropriate one. Thirdly, hypotheses and responses are not always evaluated and are therefore not revised or repaired, if the situation or the listener's feedback calls for it. These observations can be interpreted in different ways, depending on the framework. Within the framework of the structure of intellect model the lack of alternative hypotheses, plans of action, and responses suggest deficiencies in divergent production (ie, fluency, flexibility, originality, and elaboration).30 In relation to information processing and hypothesis theory,31'35 the behaviors suggest inadequacies in cogniti ve- linguistic strategy acquisition.

SUMMARY

Children and adolescents with language disorders encounter disruption in the fluency of social interaction. Because of the chronic nature of language disabilities, problems in academic achievement and success become the hallmark of the disorders during the school years. Since adolescence represents a time of experimentation and definition of the self, individuals with language disorders are at high risk for the development of fragmented and inappropriate perspectives about themselves. Treatment must address, in a functionally coordinated manner, the acquisition of essential linguistic and basic academic skills, the learning of curriculum content, and the development of appropriate perspectives of the self and the environment.

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10.3928/0090-4481-19870201-08

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