Diagnosing language disorder versus language difference in practice



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cOMBATING MISDIAGNOSES IN THE FIELD OF SPEECH LANGUAGE PATHOLOGY




jEZZICA zimmermann

Honors Capstone

SPRING 2016




INTRODUCTION

The problem of misdiagnosis between language disorder and language difference is something that has been increasingly brought to light in the past few decades. There is a plethora of information showing research to prove licensed speech language pathologists (SLPs) and students do not have accurate judgement in conducting evaluations or deciphering the correct diagnosis as they do in other areas of the field (Levey, 2013; ASHA Cultural Competence; Verdon, McLeod, & Wong, 2016; Horton-Ikard & Muñoz, 2010 ). The factors that contribute to this problem include the lack of a required multicultural course which leads to insufficient cultural competence, and the inability to identify a nonstandard English dialect from disordered speech (Levey, 2013; Social Dialects, 1983). With minority populations being most frequently misdiagnosed, the understanding of different cultures is an area SLPs need to become more versed in. This would allow SLPs to avoid giving biased tests to those populations who may not understand the context of certain questions because it is not relevant to their native culture. The aim of this study is to inform readers of the main differences in these diagnoses and find the most frequently identified symptoms between them to distinguish the two as distinctly as possible. This paper is meant to serve as a resource for parents, students, teachers, linguists and speech language pathologists.

Even after SLPs conduct their assessments, the parents know the child’s true ability better than they ever will, and this is why it is important for parents to be aware of the typical developmental milestones. The input of loved ones is very important for speech language pathologists to compare with the results of assessments and help paint a better picture of the child’s strengths and weaknesses to ensure the most accurate diagnosis. Being aware of the ongoing mistakes of others in the field can help licensed or training speech language pathologists improve themselves and become more cautious of mislabeling clients. This paper explores why this misunderstanding exists to advocate for changes and implement better education for future speech language pathologists.

LANGUAGE DISORDER

The definition of a language disorder is any difficulty with the production and/or reception of linguistic units, regardless of environment, which may range from total absence of speech to minor variance with syntax; meaningful language may be produced, with limited content. The causes of language disorders are often unknown, but some potential causes of language disorder could be: a family history of language disorders, premature birth, low birth weight, hearing impairment, autism spectrum disorder, cognitive impairments, syndromes (Fragile X, Fetal Alcohol and Down syndrome), stroke, brain injury, tumors and poor nutrition (ASHA Preschool Lang Disorders). At 44.2%, language disorders are the most common communication impairment in children ages 2 to 5. It is the second most prevalent disorder in students ages 6 through 21 at 17.9% behind specific learning impairment (SLI), which occurs in 39.5% of adolescents (ASHA Leader,2016). The National Institute of Deafness and Communicative Disorders defines SLI as “difficulty with language or the organized-symbol system used for communication in the absence of problems such as mental retardation, hearing loss, or emotional disorders (NIH, 2004).” Language disorders do often co-occur with other disabilities, especially developmental disorders such as autism spectrum disorder and cerebral palsy. The characteristics of language disorder include having greater ability for some aspects of language than others, abnormal developmental progress, and too many errors for their age level. An example of abnormal developmental progress is when a child has mastered Brown’s Morpheme #8, while still struggling with #3. Brown’s morphemes are a highly recognized chronological list of morphemes, or word markers, which presents the typical steps in the morphological development of children. Those children who do not follow this sequence are at high risk of having a language disorder. According to Brown’s 1973 article, there are 14 morphemes included which all should be acquired by the age of 4:



  1. present progressive (-ing),

  2. preposition


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