The current position on speech and language intervention for children who have pragmatic language impairment (PLI) is limited by a lack of evidence to support practice. Two intervention outcome case studies of children with PLI, aimed at establishing efficacy, are presented in this paper Standardized language tests and conversational sampling were used to assess the children pre-and post-therapy. Each child received eight weeks of intervention, three times a week, from a specialist speech and language therapist. This experi-mental treatment, which was funded as part of a research project, targeted social adaptation skills of the child and adults in his communication environment, in addition to work on communication acts, conversation and narrative skills and facilitating understanding of social inference. One child, with isolated social andpragmatic difficulties, showed measured and reported improvements in conversational skills. The second child, who has additional language disorder, showed changes in language processing skills but no changes in pragmatic abilities. The implications for choosing interventions, for the training of practitioners and questions for further research are discussed. The therapy resources used in intervention are listed.
Albert: A Second Grade Boy with an Expressive Language Disorder
Albert was referred to me by a friend of his family. When I met him he was seven years old, in second grade, and getting some speech therapy at his public school. Albert was a late talker; his mother said he was not really putting words together until he was age three. When he did begin talking, his sentences were immature-sounding and even in kindergarten and first and second grade he was making below-age-level grammar mistakes (referring to females and males both with the pronoun “he;” dropping the “is” verb occasionally; and mis-producing past tenses of verbs, especially the irregular verbs like “go-went.” He was also having difficulty with syntax (word order), especially question syntax so that when he asked me “how that get in there,” he meant” how did that get in there” Albert also had difficulty with precisely expressing his thoughts in specific words and phrases. This seemed to reflect problems with word retrieval, choosing just exactly the word needed to express his intent, and it also included difficultly organizing his thoughts into sentences that exactly expressed his intent. For example, one day he was describing a birthday party he had attended and he spoke of the birthday boy’s mother putting “firesticks” on the “birthday food thing.” When he came to a word or phrase that was hard to retrieve, he substituted a vague word or series of words that negatively affected listener understanding. Albert was also experiencing difficulty in school with reading comprehension and expression as well as writing, and spelling.
Our work in speech therapy included identifying the specific grammar targets and practicing their appropriate use first in drills and then in conversation, and also teaching strategies to help with word retrieval. We worked especially hard on understanding the meanings of the words “vague” and “specific” by practicing identifying utterances as either “vague” or “specific” and then using specific utterances to describe pictures and real-life occurrences. I stayed in close contact with Albert’s school speech-language pathologist while I worked with this young man.
Return to Case Studies »