Language Disorders: A Functional Approach to Assessment

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Library of Congress Cataloging-in-Publication Data

Owens, Robert E.
Language disorders : a functional approach to assessment and intervention / Robert E. Owens Jr. — 6th ed.
   p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-13-297872-9
ISBN-10: 0-13-297872-5
I. Title.
[DNLM: 1. Language Disorders. 2. Child. 3. Infant. 4. Language Therapy. WL 340.2]
616.85'5—dc23
2012049057

10 9 8 7 6 5 4 3 2 1

ISBN 10: 0-13-297872-5

ISBN 13: 978-0-13-297872-9
Contents
Preface  ix

1 A Functional Language Approach  1

Traditional and Functional Models  3
Role of Pragmatics in Intervention  5
Dimensions of Communication Context  6
Summary  7
Role of Generalization in Intervention  7
Variables That Affect Generalization  8
Summary  13
Evidence-Based Practice  13
Conclusion  15

2 Language Impairments  17
Information Processing  21
Diagnostic Categories  23
Intellectual Disability  23
Learning Disability  30
Specific Language Impairment  37
Pervasive Developmental Disorder/Autism Spectrum Disorder  47
Brain Injury  54
Maltreatment: Neglect and Abuse  57
Other Language Impairments  59
Implications  61
Conclusion  62

3 Early Communication Intervention  65

Legal Basis for Early Intervention  66
Early Intervention Model  67
Team Approach  67
Importance of Families  68
Cultural Concerns  68
Child and Parents/Caregivers  69
Individualized for Each Child  69
Individualized Family Service Plan (IFSP)  69
Natural Environment  70
Role of the SLP  71
Children Served in ECI Programs  71
Established Risk  72
At-risk Children  75
ECI Assessment  78

iii
iv Contents

Transdisciplinary Model of Assessment  79

Family Concerns, Priorities, and Resources  80
Informal Communication Assessment  80
Formal Assessment of Infants and Toddlers  84
Assessment Steps  85
Intervention  89
Intervention Strategies  89
Natural Settings and Partners  90
A Hybrid Model  91
Augmentative and Alternative Communication  93
Types of AAC  93
Evidence-Based Practice  94
Assessment  95
AAC Intervention  97
Summary  100
Conclusion  101

4 Assessment of Preschool and School-age Children with

Language Impairment  103
Psychometric versus Descriptive Procedures  104
Psychometric Assessment Protocols  107
Test Differences  107
Content  107
Misuse of Normative Testing  107
Variables in Test Selection  110
Summary  111
Descriptive Approaches  112
Reliability and Validity  112
Summary  114
An Integrated Functional Assessment Strategy  114
Questionnaire, Interview, and Referral  115
Observation  116
Formal Testing  118
Sampling  126
Assessment for Information-Processing Deficits  126
Conclusion  129

5 Assessment of Children with Culturally and Linguistically Diverse

Backgrounds  131
State of Service Delivery  133
Lack of Preparation and Unfamiliarity with Different
Languages and Cultures  133
Lack of Appropriate Assessment Tools  138
Overcoming Bias in Assessment of ELLs  139
Use of Interpreters  140
Overcoming Bias in Assessment of African American Children  141
An Integrated Model for Assessment  142
 Contents v

Summary  149
Conclusion  150

6 Language Sampling  151
Planning and Collecting a Representative Sample  152
Representativeness  153
A Variety of Language Contexts  153
Preschool and Early School-age Children Sampling Contexts  154
Evocative Conversational Techniques  160
Language Sampling of Children with CLD Backgrounds  167
Recording the Sample  169
Transcribing the Sample  170
Collecting Samples of Written Language  173
Conclusion  174

7 Language Sample Analysis  175

Across Utterances and Partners  176
Stylistic Variations  176
Referential Communication  178
Cohesive Devices  180
Communication Event  182
Social versus Nonsocial  183
Conversational Initiation  183
Topic Initiation  184
Conversation and Topic Maintenance  185
Duration of Topic  187
Topic Analysis Format  188
Turn Taking  192
Conversation and Topic Termination  194
Conversational Breakdown  194
Within Utterances  197
Language Use  198
Content  201
Form  206
Computer-Assisted Language Analysis  221
Conversational Partner  222
Conclusion  223

8 Narrative Analysis  225
Scripts and Narrative Frames  226
Collecting Narratives  227
Narrative Analysis  229
Narrative Levels  230
High-Point Analysis  231
Story Grammars  232
Expressive Elaboration  235
vi Contents

Quantitative Measures  237
Cohesive Devices  238
Reliability and Validity  241
Children with CLD Backgrounds  242
Narrative Collection and Analysis  242
Conclusion  244

9 A Functional Intervention Model  245

Principles  247
The Language Facilitator as Reinforcer  247
Close Approximation of Natural Learning  248
Following Developmental Guidelines  248
Following the Child’s Lead  249
Active Involvement of the Child  250
Heavy Influence of Context on Language  250
Familiar Events Providing Scripts  250
Designing a Generalization Plan First  251
Generalization Variables  251
Training Targets  251
Training Items  252
Method of Training  253
Language Facilitators  255
Training Cues  261
Contingencies  262
Location  263
Conclusion  263

10 Manipulating Context  265
Nonlinguistic Contexts  266
Linguistic Contexts  268
Modeling  268
Direct Linguistic Cues  271
Indirect Linguistic Cues  272
Contingencies  273
Top-Down Teaching  278
Conclusion  279

11 Specific Intervention Techniques  281

Pragmatics  282
Intentions  283
Conversational Abilities  287
Narration  292
Semantics  296
Inadequate Vocabulary  296
 Contents vii

Semantic Categories and Relational Words  300

Word Retrieval and Categorization  305
Comprehension  308
Syntax and Morphology  314
Morphology  314
Verb Tensing  315
Pronouns  318
Plurals  319
Articles  319
Prepositions  320
Word Order and Sentence Types  320
Summary  323
Children with CLD Backgrounds  323
Use of Microcomputers  325
Conclusion  326

12 Classroom Functional Intervention  327

Background and Rationale: Recent Educational Changes  328
Response to Intervention (RTI)  329
Inclusion  331
Collaborative Teaching  332
Summary  333
Role of the Speech-Language Pathologist  333
Relating to Others  334
Language Intervention and Language Arts  335
Elements of a Classroom Model  335
Identification of Children at Risk  335
Curriculum-Based Intervention  341
Linguistic Awareness Intervention within the Classroom  344
Language Facilitation  350
Instituting a Classroom Model  356
Conclusion  358

13 Literacy Impairments: Language in a Visual Mode  361

Reading  362
Reading Problems  363
Children with CLD Backgrounds  367
Assessment of Reading  368
Intervention for Reading Impairment  372
Writing  384
Writing Problems  385
Assessment of Writing  387
Intervention for Writing Impairment  390
Conclusion  394
viii Contents

Appendices

A Considerations for CLD Children  395

B Language Analysis Methods  403

C Selected English Morphological Prefixes and Suffixes  411

D Indirect Elicitation Techniques  413

E Intervention Activities and Language Targets  415

F Use of Children’s Literature in Preschool Classrooms  419

Glossary  429

References  433

Author Index  469

Subject Index  479
Preface

T
he sixth edition of Language Disorders: A Functional Approach to Assessment and Interven-
tion represents an exhaustive compilation of studies conducted by my professional col-
leagues and of several years of my own clinical work in speech-language pathology with
both presymbolic and symbolic children and adults. In this book, I concentrate on children because
of the special problems they exhibit in learning language. Adults who are acquiring language, or
who have lost language and are attempting to regain it, represent a diverse group that would be dif-
ficult to address also in this text.
I call the model of assessment and intervention presented in this text functional language. This
approach goes by other names, such as environmental or conversational, and includes elements of
several other models. Where I have borrowed someone’s model, ideas, or techniques, full credit is
given to that person. I find assessment and intervention to be an adaptation of a little of this and a
little of that within an overall theoretical framework. Readers should approach this text with this in
mind. Some ideas presented are very practical and easy to implement, whereas others may not apply
to particular intervention settings. Readers should use what they can, keeping in mind the overall
model of using the natural environment and natural conversations as the context for training lan-
guage. I am the first to acknowledge that I do not have a monopoly on assessment and intervention
methods, nor do I pretend to have all of the answers.
Within Language Disorders I have made some content decisions that should be explained. I
group all children with language problems, both delays and disorders, under the general rubric of
language-impaired. This expedient decision was made recognizing that this text would not be ad-
dressing specific disorder populations except in a tangential manner.
Hopefully, you’ll be pleased with the sixth edition. Professors who’ve used the text before will
notice some new additions and changes in emphasis. These are based on professional feedback,
reviewers’ comments, student input, and the changing nature of speech and language services. Here
is a partial list of updates and modifications.

• The text is thoroughly updated with the addition of several hundred new sources. This is
the result of nearly as many hours of reading or perusing journal articles. In all honesty, I
also looked at five other texts on this topic to see how the authors organized and explained
language impairment.
• I’ve added a new chapter on early communication intervention as some reviewers sug-
gested. This is a topic near and dear to my heart, and the model espoused by both the U.S.
government and the American Speech-Language-Hearing Association is a functional one.
• I’ve included a large section on augmentative and alternative communication (AAC). Al-
though strictly speaking, AAC is a mode of communication and not language intervention
per se, many of the issues that must be addressed relate to language, and for some children
learning language and communication without AAC may be almost impossible.
• New developments, such as inclusion and Response to Intervention or RTI have been add-
ed to the classroom intervention chapter in recognition of the effect these are having on
what happens in the public schools.
• Since the last edition, the information on Specific Language Impairment and working
memory has exploded, so readers will find this section greatly expanded over the previous
edition.

ix
x Preface

• The number of children diagnosed with some variant of autism spectrum disorder (ASD)
has continued to explode. I have attempted to expand discussion of this topic and new inci-
dence figures and descriptive criteria.
• Luckily, the number of meta-analyses focusing on the best evidence-based practices has
greatly increased since the last edition, although as a profession, speech-language patholo-
gists (SLPs), especially those concerned with language intervention, still lag behind some
other medical or medical-related professions. Wherever I have been able to find these pro-
fessional articles, I have incorporated their results, even when they don’t conform to what I
might believe. That’s how we learn and stay current, isn’t it?
• The chapters on language analysis have been strengthened and consolidated into one and
the discussion tightened to add more cohesion. In the past, these chapters tended to ramble
on about the possibilities for analysis at the expense of the more important how-to.
• As in previous editions, I have included all the relevant information on children from cul-
turally and linguistic diverse backgrounds. I’m in love with the increasingly diverse nature
of U.S. society and believe it’s essential that we serve those children who need our services to
the best of our ability.

No doubt I’ve forgotten some of the changes. I hope you are pleased with the results.
I hope that you will find this text useful. Those who use the methods found within these pages
tell me that they and their clients find them to be useful, effective, adaptable, and fun. Time will tell
if you agree.

Acknowledgments

No text is written without the aid of other people. First, I thank the reviewers of this edition; I have
tried to heed their sound advice.
No text is undertaken by the author alone, and I have been fortunate to have the support of
some wonderful people. First, I must acknowledge my colleagues at my former employer who each
nurtured me and encouraged me for so many years. These include Linda House, Ph.D., department
chair, and in alphabetic order, Rachel Beck, Irene Belyakov, Linda Deats, Brenda Fredereksen, Bev-
erly Henke-Lofquist, Doug and Cheryl MacKenzie, Dale Metz, Diane Scott, Gail Serventi, and Bob
Whitehead. Wow, what a great bunch of folks!
I also owe a big thanks to the faculty and staff at my new home in the Department of Commu-
nication Sciences and Disorders at The College of St. Rose in Albany, NY, for believing in me and
offering me a spot on their faculty. Their program is exciting and dynamic, and I’m looking forward
to my association with them.
I would also like to thank the reviewers for this edition: Joan S. Klecan-Aker, Texas Christian
University; Edgarita Long, Northeastern State University; and Gregory C. Robinson, University of
Arkansas at Little Rock.
In addition, special thanks and much love to my partner at O and M Education, Moon Byung
Choon, for his patience, support, and perseverance. Finally, my deepest gratitude to Dr. James Mac-
Donald, retired from the Department of Speech Pathology and Audiology, The Ohio State University, for
introducing me to the potential of the environment in communication intervention.
About the Author
Robert E. Owens, Jr. Ph.D. (“Dr. Bob”) is an As-
sociate Professor of Communication Sciences and
Disorders at the College of St. Rose in Albany, NY,
and a New York State Distinguished Teaching Pro-
fessor. He teaches courses in language development
and language disorders and is the author of

• Language Development, An Introduction

(8 editions)
• Language Disorders, A Functional Approach
(6 editions)
• Program for the Acquisition of Language with
the Severely Impaired (PALS)
• Help Your Baby Talk, Introducing the
New Shared Communication Method
• Queer Kids, The Challenge and Promise for
Lesbian, Gay and Bisexual Youth

His Language Development text is the most widely used in the world and has been translated
into Spanish, Korean, Arabic, and Mandarin. He has also co-authored Introduction to Communica-
tion Disorders, A Life Span Perspective (4 editions), written a score of book chapters and professional
articles, and authored two as-yet unpublished novels that are sure to win a posthumous Pulitzer prize.
Currently, he is authoring a text on early intervention. In love with the sound of his own voice, Dr.
Bob has presented over 180 professional papers and workshops around the globe. His professional
interests are language disorders in infants, toddlers, and preschoolers, who are also some of his best
friends. And he’s a gran’pa!

xi
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 Chapter
A Functional Language
Approach 1

1
2 Chapter 1 A Functional Language Approach

A
t the risk of sounding like I think I’m something special, which I don’t and I’m not, let me
begin with two vignettes. A few years ago, I gave a presentation in Buffalo, New York, on a
topic other than speech-language pathology and was pleased to see a former student sitting
in the rear. Afterward, when I approached her and expressed my surprise at seeing her in attendance,
she told me she was there not because of the topic but because she wanted to tell me how much she
appreciated the functional intervention methodology I had shared with her in class several years
earlier. At the time, according to her, she thought I was describing a standard method of providing
intervention and was not aware until she graduated just how different functional intervention is from
typical intervention as practiced by her peers. She related to me that, years after graduating, she is still
being questioned by colleagues who wondered how she learned to make therapy look so natural and
to engage children so well while genuinely seeming to enjoy herself. I can’t take credit for that. All I
did was provide information. She is a bright, creative speech-language pathologist who was able to
implement what she had learned.
After another workshop in Connecticut, an older speech-language pathologist approached me
to tell me she used many functional methods she had read in this book and found them to be very
effective. Somewhat humbled, I thanked her, but as I moved on, she took my arm firmly and said,
“You don’t understand. I get it. I get it.” As I turned back to her, she explained that functional
intervention is not the same as using someone’s published language intervention program, it’s a
philosophy of intervention that influences everything she does with children and adults with lan-
guage impairment.
Both women get it. In this book, we are going to explore that “it,’’ a functional philosophy of
language intervention. I want you to get “it” too. There are many pieces to this model, but luckily, an
inability to use some portions, such as working with parents, does not preclude using others, such
as teaching through conversation. Nor does use of functional methods negate the need for more
traditional methods with some clients and at some times during intervention. But with a functional
approach firmly in your mind, you never lose sight of the goal. You never lose sight of intervention
based on actual use of the newly trained skill to improve communication. All your clinical decisions
should move your clients in that direction.
I’ve been an SLP and college professor for thirty-five years, but I began my career just as you
are, sitting in classes, taking notes, reading texts, and eager but fearful of my first clinical experience.
This book is my attempt to give you as much information about language impairment as possible in
the shortest space possible. The text is thick and filled with information because this topic is compli-
cated. We’ll discuss groups of children as we move through our discussion, children with intellectual
disability and others with autism spectrum disorder. Even after we have spent all these words in
discussing the topic, we will have only skimmed the surface. You will spend your professional career
continually updating your knowledge. And yet, each new child with a language impairment that you
meet will challenge your knowledge, your skill, and your creativity. It’s what makes the field of lan-
guage impairment so challenging and rewarding.
So let’s proceed together. If you have concerns as we go, if I’ve made a mistake or confused you,
or if I’ve been insensitive about a topic at some point, please let me know. I value your input.
Throughout this book, to the best of my ability, I have used evidence-based practice (EBP) as
the basis for this text. I have attempted to research each topic, weigh the data, and make informed
decisions prior to passing the knowledge on to you. If you are unfamiliar with EBP, I’ll explain it at
the end of the chapter. For now, let’s begin with the basic concepts of language impairment and
functional language intervention.
Language is a vehicle for communication and is primarily used in conversations. As such, lan-
guage is the social tool that we use to accomplish our goals when we communicate. In other words,
language can be viewed as a dynamic process. If we take this view, it changes our approach to language
intervention. We become interested in the how more than in the what. It is that aspect of language
intervention that I wish for us to explore through this book.
 Chapter 1 A Functional Language Approach 3

The American Speech-Language-Hearing Association, the professional organization for speech-

language pathologists and audiologists, defines language disorder as follows:

A LANGUAGE DISORDER is impaired comprehension and/or use of spoken, written and/or

other symbol systems. This disorder may involve (1) the form of language (phonology, mor-
phology, syntax), (2) the content of language (semantics), and/or (3) the function of language in
communication (pragmatics) in any combination. (Ad Hoc Committee on Service Delivery in
the Schools, 1993, p. 40)

For our purposes, we shall consider the term language disorder, which l’ll call language impair-
ment, to apply to a heterogeneous group of developmental disorders, acquired disorders, delays, or any
combination of these principally characterized by deficits and/or immaturities in the use of spoken and/
or written language for comprehension and/or production purposes that may involve the form, content,
or function of language in any combination. Language impairment may persist across the lifetime of
the individual and may vary in symptoms, manifestations, effects, and severity over time and as a
consequence of context, content, and learning task. Language differences, found in some individuals
who are English Language Learners (ELLs) and those using different dialects, do not in themselves
constitute language impairments.
In attempting to clarify the definition of language impairment, we have, no doubt, raised more
questions than we have answered. For example, causal factors, such as prematurity, although impor-
tant, are omitted from the definition because of their diverse nature and the lack of clear causal links
in many children with language impairment (LI). In general, causal categories are not directly related
to many language behaviors. Likewise, diagnostic categories, such as traumatic brain injury, are not
included in my definition for many of the same reasons. The definition also states that language dif-
ferences are not disorders, even though the general public and some professionals often confuse the
two. We’ll explore all of these issues in Chapter 2 and the chapters that follow. For now, relax a little
and let’s discuss functional language intervention.
The professional with primary responsibility for habilitation or rehabilitation of LI is the speech-
language pathologist (SLP). The wearer of many hats, the SLP serves as team member, team teacher,
teacher and parent trainer, and language facilitator.
These many roles reflect a growing recognition that viewing the child and his or her commu-
nication as the sole problem is an outmoded concept, and increasingly, language intervention is
becoming family centered or environmentally based, such as in a classroom. Professional concern
is shifting from training targets such as individual morphological endings or vocabulary words to
a more functional, holistic approach focusing on the child’s overall communication effectiveness.

Traditional and Functional Models

A functional language approach to assessment and intervention, as described in this text, targets
language used as a vehicle for communication. It’s a communication-first approach. The focus is
the overall communication of the child with language impairment and of those who communicate
with the child. As stated, the goal is better communication that works in the child’s natural com-
municative contexts.
In a functional language approach, conversation between children and their communication
partners becomes the vehicle for change. By manipulating the linguistic and nonlinguistic contexts
within which a child’s utterances occur, the partner facilitates the use of certain structures and pro-
vides evaluative feedback while maintaining the conversational flow. That last sentence is worth
rereading. From the early data collection stages through the intervention process, the SLP and other
communication partners are concerned with the enhancement of the child’s overall communication.
4 Chapter 1 A Functional Language Approach

Functional language approaches have been used in clinical research to increase mean length of
utterance and multiword utterance production; the overall quantity of spontaneous communication;
pragmatic skills; vocabulary growth; language complexity; receptive labeling; and intelligibility and
the use of trained forms in novel utterances in children with intellectual disability, autism spectrum
disorder, specific language impairment, language learning disability, developmental delay, emotional
and behavioral disorders, and multiple handicaps. Even minimally symbolic children who require a
more structured approach benefit from a conversational milieu. In addition, functional interactive
approaches improve generalization even when the immediate results differ little from those of more
direct instructional methods. Finally, a conversational approach yields more positive behaviors from
the child, such as smiling, laughing, and engagement in activities, with significantly more verbal ini-
tiation, than does a strictly imitation approach. In contrast, the child learning through an imitation
approach is more likely to be quiet and passive.
In the past, the traditional approach to teaching language has been a highly structured, behavioral
one emphasizing the teaching of specific language features within a stimulus-response-reinforcement
model. Thus, language is not seen as a process but a product or response elicited by a stimulus or
produced in anticipation of reinforcement.
Stimulus-response-reinforcement models of intervention have often taken the form of questions
by an SLP and answers by a child or directives by an SLP for a child to respond. Typical stimulus
utterances by an SLP might include the following:

Which one sounds better . . . or. . . . ?

Did I say that correctly?
Tell me the whole thing.
Say that three times correctly.

In a more traditional model of intervention, the SLP’s responses are based on the correctness of
production and might include Good, Good talking, Repeat it again three times, Listen to me again, and
so on. Table 1.1 offers a simplified comparison of the traditional and functional models.

Table 1.1 Comparison of Traditional and Functional Intervention Models

Traditional Model Functional Model

Individual or small group Individual, small group, large group, or an entire class
Clinical situation Actual communication situation
Isolated language targets Relationship of linguistic units stressed as target is used
in conversation
Begin with small units of language and build up Target conversation as “fixing” the child’s language as
to conversation needed with minimal prompts
Stress on modeling, imitation, practice, and Conversational techniques stressing successful
drill communication
Use in conversations stressed in final stages of Use is optimized as a vehicle for intervention
intervention
Child’s behavior and language constrained by Increased opportunity to use the new language feature in
adult a wide variety of contexts
Little real conversation and use Premised on real conversation and use
Little involvement of significant others Parents and teachers used as agents of change
 Chapter 1 A Functional Language Approach 5

Many SLPs prefer a traditional structured approach because they can predict accurately the
response of the child with LI to the training stimuli. In addition, structured behavioral approaches
increase the probability that the child will make the appropriate, desired response. Language lessons
usually are scripted as drills and, therefore, are repetitive and predictable for the SLP.
In a structured behavioral approach the child can become a passive learner as the SLP manipu-
lates stimuli in order to elicit responses and dispense reinforcement. The SLP’s overall style is highly
directive. In other words, the clinical procedure is unidirectional and trainer-oriented. Unfortunately,
used alone, these approaches are inadequate for developing meaningful uses for the newly acquired
language feature.
Although structured behavioral approaches that exhibit intensity, consistency, and organization
have been successful in teaching some language skills, they exhibit a major problem — generalization
of that learning from clinical to more natural contexts. As such, failure of language-training targets
to generalize to other uses is one of the major criticisms of intervention with children with autism
spectrum disorders.
Lack of generalization can be a function of several factors, including the material selected for
training, the learning characteristics of a child, or the design of the training. Stimuli present in the
clinical setting that directly or indirectly affect learning may not be found in other settings. Some of
these stimuli, such as training cues, have intended effects, whereas others, such as an SLP’s presence,
may have quite unintended ones. In addition, clinical cues and consequences used for teaching, such
as reinforcement, may be very different from those encountered in everyday situations, thus remov-
ing the motivation to use the behavior elsewhere.
In contrast, functional approaches give more control to a child and decrease the amount of
structure in intervention activities. Measures of improvement are increased successful communica-
tion, not just the number of correct responses. Procedures used by an SLP and a child’s communi-
cation partners more closely resemble those in the language-learning environment of children. In
addition, the everyday environment of a child with LI is included in the training.
Naturally, the effectiveness of any language-teaching strategy will vary with the characteristics
of the child with LI and the content of training. For example, children with learning disabilities may
benefit more from specific language training than do other children with language impairment.
Likewise, children with more severe LI initially benefit more from a structured imitative approach.
In this chapter, we’ll further define a functional language approach and explore a rationale for it.
This rationale is based on the primacy of pragmatics in language and language intervention and on
the generalization of language intervention to everyday contexts. Generalization is discussed in terms
of the variables that influence it.

Role of Pragmatics in Intervention

As you’ll recall, pragmatics consists of the intentions or communication goals of each speaker and of the
linguistic adjustments made by each speaker for the listener in order to accomplish these goals. Most fea-
tures of language are affected by pragmatic aspects of the conversational context. For example, a speak-
er’s selection of pronouns involves more than syntactic and semantic considerations. The conversational
partners must be aware of the preceding linguistic information and of each other’s point of reference.
In an earlier era, interest by SLPs in psycholinguistics led to a therapeutic emphasis on increasing
syntactic complexity. With a therapeutic shift in interest to semantics or meaning in the early 1970s
came a new recognition of the importance of cognitive or intellectual readiness but little understand-
ing of the importance of the social environment. The influence of sociolinguistics and pragmatics in
the late 1970s and 1980s has led to interest in conversational rules and contextual factors. Everyday
contexts have provided a backdrop for linguistic performance.
Among those working with special populations, the focus has been shifting to the communica-
tion process itself. Previously, for example, children’s behaviors were considered either appropriate
6 Chapter 1 A Functional Language Approach

or inappropriate to the stimulus-reinforcement situation. Echolalia and unusual language patterns

considered inappropriate were extinguished or punished. When emphasis shifts to pragmatics and to
the processes that underlie behavior, however, the child’s language, even echolalia, can be considered
on its own terms. For example, does it serve a purpose for the child?
Older approaches have tended to emphasize childrens’ deficits with the goal of fixing what’s
wrong. In contrast, a functional approach stresses what a child needs in order to accomplish his or
her communication goals. It follows that intervention should provide contexts for actively engaging
children in communication. In shifting the focus from the disorder to supporting a child’s communi-
cation, the goal becomes increasing support and opportunities for the child to participate in everyday
communication situations.
Increasingly, SLPs are recognizing that the structure and content of language are heavily influ-
enced by the conversational constraints of the communication context. This view of language neces-
sitates a very different approach to language intervention. In effect, intervention has moved from
an entity approach, which targets discrete isolated bits of language, to a systems or holistic approach,
which targets language within the overall communication process. The major implication is a change
in both the targets and the methods of training. If pragmatics is just one of five equal aspects of lan-
guage, as seen in Figure 1.1, then it offers yet another set of rules to train and the methodology need
not change. The training still can emphasize the what with little change in the how, which can con-
tinue in a structured behavioral paradigm.
In contrast, an approach in which pragmatics is seen as the overall organizing aspect of language,
also seen in Figure 1.1, necessitates a more interactive conversational training approach, one that mir-
rors the environment in which the language will be used. Therapy becomes bidirectional and child
oriented, and conversation is viewed as both the teaching and transfer environment.

Dimensions of Communication Context

Language is purposeful and takes place within a dynamic context that affects form and content and
may, in turn, be affected by them. Context consists of a complex interaction of many factors:

Purpose. Language users begin with a purpose that affects what to say and how to say it. Here’s
pragmatics again.

Formalist Functionalist

Syntax Pragmatics

Syntax
Mor
y
olog

phol

Morphology
Phonology
Phon

ogy

Semantics
Sema cs
ntics mati
Prag

Pragmatics is one of five equal and Pragmatics is the overall

interrelated aspects of language. organizing aspect of language.

Figure 1.1 Relationship of the aspects of language.

 Chapter 1 A Functional Language Approach 7

Content. Language users communicate about something. This topic affects the form and the
style.
Type of discourse. Certain types of discourse, such as a debate or a speech, use a characteristic
type of structure related to the purpose.
Participant characteristics. Participant characteristics that affect context are background
knowledge, roles, life experiences, moods, willingness to take risks, relative age, status,
familiarity, and relationship in time and space. Each participant also belongs to a speech
community, which is that group with whom he or she shares certain rules of language.
Setting and Activity. Setting and the activity includes the circumstances in which language users
find themselves, which, in turn, affects language, especially the choice of vocabulary.
Mode of discourse. Speech, sign, and written modes require very different types of interaction
from the participants.

Within a conversation, participants continually must assess these factors and their changing relation-
ships. Now, it should be easy to see why the pragmatic context is essential to effective intervention.
An SLP must be a master of the conversational context. Unfortunately, it is too easy to rely
on overworked verbal cues, such as “Tell me about this picture” or “What do you want?” to elicit
certain language structures. As simple a behavior as waiting can be an effective intervention tool
when appropriate. Similarly, a seemingly nonclinical utterance, such as “Boy, that’s a beautiful red
sweater,” can easily elicit negative constructions when directed at a child’s green socks. If an SLP
knows the dimensions of communication context and understands the dimensions, he or she can
manipulate them more efficiently.

Summary
In the clinical setting, SLPs need to be aware of the effects of context on communication. How well
children with LI regulate their relationships with other people depends on their ability to monitor
aspects of the context. Given the dynamic nature of conversational contexts, it is essential that inter-
vention also address generalization to the child’s everyday communication contexts.

Role of Generalization in Intervention

One of the most difficult aspects of therapeutic intervention in speech-language pathology is gen-
eralization, or carryover, to nontraining situations. Time and again, we SLPs bemoan the fact that
although Johnny performed correctly during intervention, he could not transfer this performance to
the playground, classroom, or home. When language features taught in one setting are not generalized
to other content and contexts, the child’s goal of communicative competence is not realized.
For our purposes, let’s consider generalization to be the ongoing interactive process of clients
and their newly acquired language feature with the communication environment (Figure 1.2). For
example, if we are trying to teach a child the new word doggie, we might repeat the word several times
in the presence of the family dog and then cue the child with “Say doggie.” If the child repeats the
word only in this situation, she has not learned to use the word. If she says the word spontaneously
and in the presence of other dogs, however, then we can reasonably assume that the child has learned
the word and its use. In other words, the trained content has generalized.
The factors that affect generalization lie within the training content, the learner, and the teaching
context but will vary as particular aspects of the teaching situation change. If a response is to occur in
a nontraining situation, such as a classroom, then some aspects of that situation should be present in
the training situation to signal that the response should occur. In other words, an SLP must consider
the effects of the various teaching contexts on generalization to everyday contexts.
8 Chapter 1 A Functional Language Approach

Newly learned
Learner behavior or language
feature

Environment

Generalization is the interaction of the individual, the newly trained behavior or

language feature, and the environment. All three must be present for
generalization to occur.

Figure 1.2 Generalization schematic.

Language training may not generalize because it is taught out of context, represents neither a
child’s communicative functions nor linguistic knowledge or experiences, or presents few commu-
nicative opportunities. To some extent, generalization is also a result of the procedures used and of
the variables manipulated in language training. Finally, the very targets chosen for remediation may
contribute to a lack of carryover.
With each client, an SLP needs to ask: Will this procedure (or target) work in the child’s everyday
environment? Is there a need within the everyday communication of the client for the feature that is
being trained, and do the methods used in its teaching reflect that everyday context? In a recent meet-
ing with a student SLP, the answer to these questions was no. As a result, we decided to forgo auxiliary
verb training with a middle-aged adult with intellectual disability in favor of communication features
more likely to be used within the client’s everyday communication environment, such as ordering at a
fast-food restaurant, asking directions, and using the telephone. In other words, we opted for a more
functional approach that targeted useful skills in the everyday environment of the client.

Variables That Affect Generalization

Generalization is an essential part of learning. Even the young child using his or her first word must
learn to generalize its use to novel content. At first the word doggie may be used with other four-
legged animals. From feedback—“No, honey, that’s a kitty”— the child abstracts those cases in which
the word doggie is correct and those in which it is not. The child is learning those contexts that obli-
gate the use of doggie and those that preclude its use. In other words, the child learns which contexts
regulate application of language rules.
Likewise, a young child who can say, “May I have a cookie, please?” has not learned this new
utterance until it is used in the appropriate contexts. A child learns the appropriate contextual cues,
such as the presence of cookies, that govern use of the utterance.
 Chapter 1 A Functional Language Approach 9

The contexts in which training takes place influence what a child actually learns. In fact, correct-
ness is not inherent in a child’s response itself but is found in the response in context. Saying “May I
have a cookie, please?” when none are available is inappropriate. The relationship of context to learn-
ing is not a simple one, and the stimuli controlling a response may be multiple.
In a similar way generalization is an integral part of the language intervention process. Thoughts
on generalization should not be left until after intervention has occurred. Generalization is not a
single-line entry at the end of the lesson plan, nor is it homework.
To facilitate the acquisition of truly functional language—language that works for the child—it
is essential that SLPs manipulate the variables related to generalization throughout the therapeutic
process. In a functional model, generalization is an essential element at every step. Table 1.2 includes
a list of the major generalization variables.
Generalization variables are of two broad types: content generalization and context generaliza-
tion. Content is the what of training. Content generalization occurs when the child with LI induces a
language rule from examples and from actual use. Thus, the new feature (e.g., plural -s) may be used
with content not previously trained, such as words not used in the therapy situation. Content gener-
alization is affected by the targets chosen for training, such as the use of negatives, and by the specific
choice of training items, such as the words and sentences used to train negation.
Overall, the content selected for training reflects an SLP’s theoretical concept of language and of
strategies for learning and the communication needs of a child. When grammatical units are targeted,
different uses or functions for those units are essential if we are to meet a child’s communication needs.
If content is the what, context is the how of training. Context generalization occurs when the
client uses the new feature, such as the use of auxiliary verbs in questions, within everyday commu-
nication, such as in the classroom, at home, or in play. In each of these contexts there are differences
in persons present and in the location, as well as in the linguistic events that precede and follow the
newly learned behavior. Generalization can be facilitated when the communication contexts of the
training environment and of the natural environment are similar in some way.
Let’s briefly look at each variable. We’ll come back to them later when we begin to design an
intervention approach in Chapter 9.

Training Targets

The very complexity of language makes it impossible for an SLP to teach everything that a child with
LI needs to become a competent communicator. Obviously, some language features must be ignored.
Target selection, therefore, is a conscious process with far-reaching implications.
Training target selection should be based on the actual needs and interests of each child within
his or her communication environments. The focus of instruction should be on increasing the effec-
tiveness of child-initiated communication. Because language is a dynamic process that is influenced
heavily by context, language features selected for training should be functional or useful for the child
in her or his communication environment.

Table 1.2 Variables That Affect Generalization of Language Training

Content generalization Training targets

Training items
Context generalization Method of training
Language facilitators
Training cues
Consequences
Location of training
10 Chapter 1 A Functional Language Approach

Although there is a tendency for beginning SLPs to target specific language deficits, such as
plural -s, as an end in themselves, intervention goals should focus on stimulating the language
acquisition process beyond the immediate target (Fey, Long, & Finestack, 2003). We can best serve
children with LI if we enhance each child’s existing resources for learning language more effectively
within the intervention context and beyond.
Not all language features occur with equal frequency. It may be necessary, therefore, to create
more frequent opportunities for a feature to occur. An SLP must create activities and modify the
environment to increase the need for the target.
Generalization is also a function of the scope of the training target and of the child’s characteris-
tics and linguistic experience with the target. In general, language rules with broad scope generalize
more easily than those with more restricted scope.
The scope of rule application can be a function of the way it is taught. Narrow, restricted teach-
ing reduces training targets to easily identifiable and observable units that may not be found in every-
day use environments. Rules interpreted by a child as applying to a limited set of items in a very
specific manner will limit generalization.
The child’s prior knowledge of language also influences generalization. The failure of training
to generalize may reflect training targets that are inappropriate for the knowledge level of a child.
For example, it would be inappropriate to train indirect commands (e.g., can you . . . ?) prior to the
child’s understanding and using yes/no questions and direct commands. A child’s underlying cogni-
tive abilities are important for target selection.
In conclusion, training targets should be selected on the basis of each child’s actual communica-
tion needs and abilities. The targets selected for training should be functional or useful in a client’s
everyday communication environment.

Training Items

The items selected for intervention, such as the specific verbs to be used in training the past tense
or the sentences to be used in training negation, and the linguistic complexity of these intervention
items also can influence generalization. In general, it is best if these items come from the natural
communication environment of the child with LI. Structured observation of this environment can
aid intervention programming. For example, an active child may use the verbs walk, jump, and hop
frequently. It is more likely that use of the past-tense -ed will generalize if these frequently occurring
words are used in the training.
Individualization is important because of the many potentially different use environments.
A child in a classroom may have very different content to discuss than does a child at home.
Targeted linguistic forms, whether word classes or larger linguistic structures, can be trained
across several functions. For example, negatives used with auxiliary verbs can occur in declaratives
(“That doesn’t fit”), imperatives (“Don’t touch that”), interrogatives (“Don’t you want to go?”) and
intentions, such as denying (“I didn’t do it”) or requesting information (“Why didn’t you go?”).
For optimum generalization, then, it is necessary to select training items from a child’s every-
day environment. In addition, these items should be trained across different linguistic forms and/or
functions and across both linguistic and nonlinguistic contexts.

Method of Training

The training of discrete bits of language devoid of the communication context actually may delay
learning and growth. Such fragmentation allows minute analysis units to eclipse the essential lan-
guage qualities of intentionality and synergy. In other words, language use is overlooked. Intervention
that focuses on these specific, discrete, structural entities fosters drills and didactic training. These, in
turn, adversely affect the flow, intentionality, and meaningfulness of language.
 Chapter 1 A Functional Language Approach 11

If language is viewed holistically, then the training of language involves much more than just
training words and structures. Clients learn strategies for comprehending language directed at them
and for generating novel utterances within several conversational contexts.
Training should occur in actual use within a conversational context. In a stroke of genius, Carol
Prutting (1983) called language intervention into question with the “Bubba” criterion. Bubba is
Yiddish for “grandmother.” If we were to explain our conversational intervention approach to our
Jewish grandmother, she would reply: “Oh, I could have told you that. It just makes sense to use
conversations to train for conversations. Why didn’t you ask me?” In other words, training in the
use of context makes sense.
Our intervention methodology should flow logically from our concept of language. If language
is a social tool and if the goal is to train for generalized use, then it follows that language should be
trained in conditions similar to the ultimate use environment. It is important, therefore, to view con-
text not as a backdrop for but as the ongoing process of intervention.
Conversational methods alone will not guarantee success for every child with LI. A successful
SLP will blend methods together as required by the child.
Discussion of the method of training leads naturally to consideration of the other contextual
variables. For optimum generalization, training should occur within a conversational context with
varying numbers of facilitators, cues, consequences, and locations.

Language Facilitators

Good language facilitators increase a child’s potential for communication success. Parents, teach-
ers, aides, and unit personnel, in addition to the SLP, can act as language facilitators because of their
relationship with and the amount of time each spends with the child. Interactional partners form
communication contexts for each other, and it is essential that the client experience newly learned
language in a number of these contexts. Because language is contextually variable, it will differ within
the context created by a child with each communication partner. Thus, generalization depends on
the number of communication partners we can involve in the intervention process.
Programs that involve a child’s communication partners, especially parents, produce greater
gains for children than do programs that do not. Parents offer a channel for generalizing to the natu-
ral environment of the home. With parent or caregiver training, both parents and teachers can func-
tion on a continuum from paraprofessionals to general language facilitators. The key in working with
families, especially in early intervention with infants and toddlers, is mutual respect and individual-
ization of services based on each family’s priorities and concerns (Sandall, McLean, & Smith, 2001).
Some cultural beliefs may be at variance with the use of parents as language facilitators. For
example, some Mexican American mothers believe that schools have the main responsibility for edu-
cating children and that parents should not be actively involved (Rodriguez & Olswang, 2003). These
same mothers are more likely than Anglo American mothers to attribute LI to factors external to the
child, such as God’s will or a child–school mismatch. Still, these mothers can be enticed into taking
an active role in language intervention if an SLP builds positive rapport and collaboration and is
respectful of culturally held beliefs.
Intervention need not be limited to just families. When daycare staff are trained to respond to
children’s initiations, to engage children, to model simplified language, and to encourage peer inter-
actions, it has a significant effect on the language production of preschool children (Girolametto,
Weitzman, & Greenberg, 2003).
With the involvement of language facilitators, the traditional role of an SLP changes. In essence,
the SLP becomes a programmer of a child’s environment, manipulating the variables to ensure suc-
cessful communication and generalization. To be effective, an SLP needs to recognize that a child’s
communication partners are also clients, as well as agents of change. The SLP acts as a consultant,
helping each child–parent dyad fine-tune its conversational behaviors.