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Language Disorders from Infancy
through Adolescence

Listening, Speaking, Reading, Writing,

and Communicating

FIFTH EDITION

Rhea Paul, PhD, CCC-SLP

Professor and Founding Chair, Department of Speech Language Pathology, Sacred
Heart University, Fairfield, Connecticut

Courtenay Norbury, DPhil

Professor, Department of Language and Cognition, Psychology and Language Sciences,
University College London, London, England

Carolyn Gosse, PhD, CF-SLP

Speech-Language Pathology Clinical Fellow, Early Childhood Special Education,
Charlottesville City Public Schools, Charlottesville, Virginia

2
Table of Contents

Cover image

Title page

Inside front cover

Copyright

Dedication

A note to the instructor

Preface

Acknowledgments
SECTION I. Topics in Childhood Language Disorders

1. Models of child language disorders

Diagnostic issues in developmental language disorders

A brief history of the field of language pathology

Terminology

Aspects and modalities of language disorder

Diagnostic issues

Etiology of developmental language disorder

Comorbidity in developmental language disorder

Conclusion

Study guide

3
2. Evaluation and assessment
General principles of assessment for suspected developmental language disorder

Beginning the assessment process: Referral, case review, and observation

Mapping the assessment plan: Why and what to assess

Choosing measures: How will we assess?

Integrating and interpreting assessment data

Conclusions

Study guide

3. Principles of intervention
The purpose of intervention

Developing intervention plans

Evaluating intervention outcomes

Prevention of language disorders in children

Conclusions

Study guide

4. Special considerations for special populations

Intellectual disability

Developmental language disorder associated with disorders of known genetic origin

Language disorders associated with sensory impairments

Developmental language disorder associated with acquired neurological disorder

Developmental language disorder associated with other neurodevelopmental disorders

Developmental language disorder associated with extreme environmental disadvantage

The nonspeaking child

Conclusion

Study guide

5. Developmental language disorders in a pluralistic society

Introduction

The culturally competent clinician

Bilingualism

Working with families

4
 Assessing culturally and linguistically different children

Summary

Language intervention with the culturally and linguistically different child

Conclusions

Study guide

Culturally and linguistically diverse students

SECTION II. From Birth to Brown’s Stage V

6. Assessment and intervention in the prelinguistic period

Family-centered practice

Service plans for prelinguistic clients

Risk factors for communication disorders in infants

Assessment and intervention for high-risk infants and their families in the newborn intensive care
nursery

Assessment and intervention for preintentional infants and their families: 1 to 8 months old

Assessment and intervention for infants at prelinguistic stages of communication: 9 to 18 months old

Considerations for older prelinguistic clients and those with autism spectrum disorders

Infants and toddlers with autism spectrum disorders

Conclusions

Study guide

7. Assessment and intervention for emerging language

Issues in early assessment and intervention

Assessing communicative intention

Assessing comprehension

Assessing productive language

Decision-making based on assessment information

From assessment to intervention

Products, procedures, and contexts of intervention for children with emerging language

Toddlers with autism spectrum disorder

Considerations for older clients in the emerging language stage

Conclusions

Study guide

Proportion of multiword utterances

5
 Semantic relations expressed in multiword utterances

Proportion of multiword utterances in “other” category

8. Assessment of developing language

Family-centered assessment

Assessing collateral areas

Screening for language disorders in the period of developing language

Using standardized tests in assessing developing language

Criterion-referenced assessment and behavioral observation for children with developing language

Considerations for the older clients with severe disabilities and those with autism spectrum disorder
at the developing language stage

Conclusions

Study guide

9. Intervention for developing language

Intervention policy issues at the developing language level

Intervention for developing language: Products, processes, and contexts

Intervention for older clients with severe impairment and autism spectrum disorder at the developing
language level

Conclusions

Study guide

SECTION III. Working with Language Learning

Disabilities

10. Language, reading, and learning in school: What the speech-language

pathologist needs to know
School-based practice in speech-language pathology

Students with language learning disabilities

Language, learning, and reading: What’s the connection?

Conclusions

Study guide

11. Assessing students’ language for learning

Child and family in the assessment process

6
 Identifying students for communication assessment

Evaluation for special educational needs

Criterion-referenced assessment and behavioral observation in the language for learning stage

Considerations for older, severely affected students at the language for learning stage

Considerations for speakers with autism spectrum disorder at the language for learning stage

Conclusions

Study guide

Percentage complex sentences

Complex sentence types

Conjunctions used

Evaluation

Plan

Narrative macrostructure

Literary language style (box 11.11)

Evaluation

12. Intervening at the language-for-learning period

Planning intervention in the language for learning stage

Intervention products in the language for learning period

Intervention processes in the language for learning period

Intervention contexts in the language for learning period

Considerations for the older clients with moderate to severe disabilities and those with autism
spectrum disorder

Conclusions

Study guide

13. Assessing advanced language

Language development in adolescence

Student-centered assessment

Screening, case finding, and establishing eligibility with standardized tests in the advanced
language stage

Criterion-referenced assessment and behavioral observation in the advanced language stage

Assessing functional communication in students with severe disabilities in the advanced language
stage

Conclusions

7
 Study guide

14. Intervention for advanced language

Issues in intervention at the advanced language stage

Products of intervention in the advanced language stage

Processes of intervention in the advanced language stage

Contexts of intervention in the advanced language stage

Special considerations for high functioning students with autism spectrum disorder

Transitional intervention planning

Conclusions

Study guide

Transition planning summary

Bibliography

Name index

Subject index

Inside back cover

8
Inside front cover
Milestones of Early Communication Development

9
Data from Chapman, R. (2000). Children’s language learning: An interactionist perspective. Journal of

10
Child Psychology and Psychiatry, 41, 33-54; Miller, J. (1981). Assessing language production in children.
Boston, MA: Allyn & Bacon; Weiss, C., Gordon, M., & Lillywhite, H. (1987). Clinical management of
articulatory and phonological disorders (ed. 2). Baltimore, MD: Williams & Wilkins.

11
Copyright

3251 Riverport Lane

St. Louis, Missouri 63043

LANGUAGE DISORDERS FROM INFANCY THROUGH ADOLESCENCE:

LISTENING, SPEAKING, READING, WRITING, AND COMMUNICATING,
FIFTH EDITION ISBN: 978-0-323-44234-3

Copyright © 2018 by Elsevier, Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by

any means, electronic or mechanical, including photocopying, recording, or any
information storage and retrieval system, without permission in writing from
the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such
as the Copyright Clearance Center and the Copyright Licensing Agency, can be
found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under
copyright by the Publisher (other than as may be noted herein).

Notices
Practitioners and researchers must always rely on their own experience and
knowledge in evaluating and using any information, methods, compounds or
experiments described herein. Because of rapid advances in the medical
sciences, in particular, independent verification of diagnoses and drug dosages
should be made. To the fullest extent of the law, no responsibility is assumed
by Elsevier, authors, editors or contributors for any injury and/or damage to
persons or property as a matter of products liability, negligence or otherwise,
or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.

12
Previous editions copyrighted 2012, 2007, 2001 and 1995.

International Standard Book Number: 978-0-323-44234-3

Content Strategist: Lauren Willis

Content Development Manager: Ellen Wurm-Cutter
Content Development Specialist: Alexandra York
Publishing Services Manager: Julie Eddy
Senior Project Manager: Marquita Parker
Designer: Ryan Cook

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

13
Dedication

To the memory of my father, who was the kind of teacher I have always tried to
be, and of my sister, whose too-short life was devoted to helping handicapped
children.

—Rhea Paul

14
A note to the instructor
This book attempts to tell students everything they ever wanted to know—and
then some—about child language disorders. It covers the entire developmental
period and delves into many additional concepts that are important to the
treatment of child language disorders, including prevention, syndromes
associated with language disorders, and multicultural practice. The fifth edition
of Child Language Disorders from Infancy through Adolescence adds to the
remarkable knowledge and energy of coauthor Dr. Courtenay Norbury by
bringing on a next-generation resource, Dr. Carolyn Gosse. Dr. Norbury is one
of the foremost young researchers in child language disorders in the world
today, and she has an astonishing command of emerging evidence on genetic,
neuropsychological, and neurophysiological aspects of child language
disorders. Her perspective adds greatly to the currency of this edition. She also
brings with her a commitment to integrating all forms of linguistic
communication into our work. Dr. Gosse has experience in literacy acquisition
and curriculum development that will also greatly enrich this edition.
In reviewing the literature since the fourth edition of this text, we continue to
see evidence of more sophisticated, rigorous evaluation of assessment and
treatment approaches. When I prepared the third edition, I found many studies
that systematically examined the efficacy of approaches that had been
advocated extensively and used widely without much basis in empirical
evidence. Preparing the fourth edition demonstrated many of these studies had
been aggregated and subjected to meta-analyses, so that the evidence in their
favor has become clearer and stronger. In preparing the fifth edition, we found
a greater number and broader range of these high levels of evidence,
particularly in interventions for school-aged children, although evidence levels
for younger children remain less fully explored. This has been one of the most
gratifying aspects of updating the text—seeing our field advance as it develops
a stronger commitment to and a broader basis for evidence-based practice.
As before, this book is relatively short on theory (although not quite so short
as it was before Dr. Norbury signed on) and long on clinical application and
concrete procedures. Our goal has been to provide a broadly based, practical
introduction to the field of language pathology to students planning a career as
clinicians in evaluating and treating children with communication disorders,
students who need to know what to do that first Monday morning of their
clinical career, but who also need to develop the ability to think critically and
creatively about the myriad kinds of clinical problems they would encounter in
the course of their practice.
Our hope is that students will use this book during their introductory

15
language disorders courses and will also find it a helpful reference as they
progress through their clinical education and even into their professional
practice. For this reason, students reading the book for the first time may feel
that it is too comprehensive, that they cannot possibly absorb all the
information in it in one or two terms. They are probably right. Our hope is that
their instructors can help them understand that they can return to the book later
and not only refresh their memories but also take in more of it as their
experience broadens and they have more background information and more
clinical savvy with which to approach it. Helping students understand that they
do not have to master the entire volume the first time through, that they will
have opportunities as their career goes on to assimilate more of the material,
can help alleviate their anxiety. What they should get from reading the book the
first time is knowledge of the basic concepts and vocabulary used in the field,
an overview of its issues and controversies, an understanding of the scope of
communicative difficulties that make up child language disorders, and a sense
of how a speech-language pathologist approaches the processes of assessment
and intervention.
In order to provide this sense, case studies and vignettes are included
throughout the book. These are meant to serve as examples of applying the
material in the text to some real-life situations. In using the case studies in class
presentations, one approach might include having students work in groups to
come up with alternative approaches to the ones given in the book for dealing
with the cases presented. This can help students develop a sense that there is no
one “right” way to deal with a client and that several different approaches
might be equally appropriate, so long as each takes the client’s needs into
account. Another way to use the case studies is to have some students present
their own clients as case studies for the chapters that apply to them. They can
use the case studies in the book as models for applying the principles discussed
in the chapter and use a similar approach to come up with an assessment or
intervention plan for a client being presented. If the students work on the case
in a cooperative learning arrangement, with several groups of four to six
students working independently to come up with a plan for the case to present
to the whole class, the diversity of possibilities for addressing a client’s needs
can again be illustrated.
As the Preface of this book states, much of the material contained here
represents the authors’ opinion or point of view. As a result, many instructors
who teach courses in child language disorders will find themselves in
disagreement with some aspects of the book’s content. Our hope is that
instructors will let students know when this happens and give them that
alternate point of view. As we’ve tried to emphasize throughout the book,
language pathology is not a field in which there are long-established sets of
accepted premises and practices. Our field is lively with controversy and
differing opinions about how to conceptualize, organize, categorize, explain,
assess, and treat child language disorders. Students should be aware of this
ferment. The best way to give them this awareness is for an instructor to focus
on points of disagreement with the text, to elaborate and explicate the

16
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