Potential Advantages of Introducing Specific Language Impairment to Families

Children with language delays 1 can be divided broadly into two groups, those with secondary and those with primary language difficulties. Children with secondary language difficulties have language difficulties that are associated with or predicted by sensory, biological, neurological, cognitive, or socioemotional deficits (e.g., hearing impairment, Down syndrome, autism). In contrast, children with primary language difficulties present with typical development with the exception of language (and in some cases concomitant speech problems). Over the years, children with primary language difficulties have been referred to in the literature and in clinical practice by a number of terms, including speech/language delay, speech/language disorder, speech/language impairment, childhood aphasia, developmental dysphasia, developmental language disorder, language learning disability, and specific language impairment (SLI). Some of these terms have been used for children with secondary language difficulties as well. There has been much discussion from a professional perspective as to the usefulness of these terms and how these terms should be applied in clinical as well as research practices (e.g., Kamhi, 1991, 1998; Lahey, 1990; Plante, 1998). There has been less discussion as to how these terms influence families’ understanding of their children’s difficulties. The purpose of this article is to advocate for the usefulness, primarily from the perspective of families, of SLI as a diagnostic category. Specific language impairment or SLI is the most prevalent term used in the research literature over the past decade to describe children with primary language difficulties (cf. Leonard, 1998), yet there does not appear to be widespread clinical use of SLI, as a label or as a diagnostic category (cf. Kamhi, 1998). Our clinical interactions led us to question why there was this disparity between research and clinical practice (cf. Wilcox & Ingram, 1998). In the course of evaluating preschool and earlyschool-age children with primary language difficulties and developing ongoing clinical relationships with families, we found that most families showed little interest in our efforts to describe their children’s language difficulties (cf. Aram, 1991). Consistent with Tomblin’s (1991) observations, families were far more interested in knowing why their children were having difficulty learning to talk, what they could do about it (beyond simply taking the child to treatment), and what to expect with regard to long-term outcomes. Time and again, families were perplexed that their children seemed quite normal or typical in many respects, yet had such pronounced language difficulties. For families who had accessed services through local school districts, the IDEA eligibility categories of “developmental delay” and “speech/language impaired” often were confusing. The parents reported that these terms did not help them understand what was wrong with their child. To adequately address families’ concerns, we found it necessary to differentiate clearly between groups of children who might have language disorders. That is, we had to clarify that their children’s language difficulties were not attributable to autism, hearing impairment, mental retardation, and so on and to establish that there exists a group of children who are typical in all respects with the exception of language. One parent in particular made us realize how important it was to have a label for her child’s condition. This mother returned to the clinic with a child development trade book in hand, opened it to the chapter on special needs, and asked “Which one of these does he have?” She wanted a label because she wanted independently to find out more about her child’s difficulties. Further, she needed to share this label with family and friends to help them understand her child. Interestingly, broad-based terms such as language delay or language disorder did not suffice, perhaps because these terms can be (and frequently are) applied to all children with language difficulties. As a result In this article, the terms “language delay” and “language difficulty” are employed as generic terms to describe all children who evidence language deficits as compared to their same-age peers, regardless of the etiology.