LANGUAGE THERAPY FOR CHILDREN: SOME THOUGHTS ON CONTEXT AND CONTENT
Audrey L. Holland University of Pittsburgh, Pennsylvania
A presentation of ideas on the ideal context for language therapy for children, this paper explores in detail the importance of teaching child language, centering language therapy in the present, teaching words with empirical significance to the child, attempting to provide a language context which is generative to unassisted later language learning, and, finally, teaching communication, not merely language skills. In addition a sample core lexicon is presented which was designed to relate the above contextual aspects of therapy to psycholinguistic strategies of language therapy.
Speech pathologists whose major interest is in developing language in languagedisordered children are presently in an excellent position to increase the effectiveness of their work. A burgeoning literature on normal language development is becoming available; and psychologists and speech pathologists with a psycholinguistic, as well as a behavioral frame of reference, are developing strategies at an astonishingly rapid rate for applying that literature to children with atypical language development. In the past year alone, for example, at least three such strategies, all appearing to be carefully reasoned and conceptually sound, have appeared in the literature (Bricker and Bricker, 1974; Miller and Yoder, 1974; McDonald and Blott, 1974). Clinicians who wish to use these or other psycholinguistically based strategies face a problem not unlike the child who is the subject of the exploding literature. They are required to sift these approaches through the filters of their perceptions and information and learn a new lexicon. They must, as language-learning children do, develop hypotheses about how the system works and subject those hypotheses to validation by trying them out in controlled and principled ways. Language clinicians appear to be grappling successfully with psycholinguistics in its broadest application to speech pathology, as the data presented by Bricker and Bricker, Miller and Yoder, and McDonald and Blott in the above-referenced works suggest that more children are learning more language. However, our success has uncovered a new set of quite intriguing concerns. Now that we have a clearer idea of what we are doing, how can we do it more parsimoniously? How can we ensure that the language taught in clinic or classroom will be of use to the child in his natural environment? T h e author be514
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HOLLAND:LanguageTherapy 515 lieves that answers to these questions can be sought most fruitfully in the clinical context and in the semantic content of language therapy. Context is used here with its standard meaning, that of the interrelated environmental conditions in which language therapy takes place; content simply refers to the words focused on in therapy. This paper is addressed to those two areas, context and content, as they might be manipulated for richer gains in language therapy. T h e first part of the paper discusses five contextual matters which appear to this writer to be critical for an effective, psycholinguistically based language therapy. T h e second part presents an example of a core lexicon compatible with the contexts described in the first part and the rationales for each word chosen. Diagnostic categories of language disorders are ignored in this paper because I am convinced that the context and content described are relevant to all language disorders. There may well be many other contexts specific to braindamaged children, hearing-impaired children, and mentally retarded children, but they are outside the purview of this paper. THE CONTEXT
Learning Childrenese Some years ago, McNeil1 (1966) noted with bewilderment that adult grammar was used in teaching deaf children and, in turn, was expected of them. Reasoning that normal children do not learn a few words and then start stringing them together as adults do, he found it difficult to comprehend our expectations that children with the kind of profound language problems deafness engenders could do so. If we accept a developmental psycholinguistic frame of reference, McNeill's objections can be addressed at least as far as grammar is concerned. By definition, developmental models for therapy teach child, not adult, grammar. 1 Since psycholinguistic strategies for work with children begin with early grammatical forms, the clinician who attempts to use them still must make psycholinguistic decisions about teaching single words that combine into a rudimentary grammar. Thus the clinician must consider carefully the function of one-word utterances in children's speech. Earliest single-word utterances are not necessarily labels but also can connote far more complex ideas. For example, the word water does not always simply refer to the liquid in question, but probably means the child wants some, or that he is in some, or has made some, or that his mother is to look at some, or even some meaning not apparent on first hearing to the adult involved. In this sense, one-word utterances are holophrastic in nature. In relit behooves the clinician using the models to assimilate the work on which these models are based, of course. Three recommended texts are: R. Brown, A First Language (1973); P. Dale, Language Development (1972); and R. Schiefelbusch and L. Lloyd (Eds.), Language Perspective: Acquisition, Retardation and Intervention (1974).
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viewing the literature on holophrastic speech, McNeill (1970, p. 23) points out that: Children never utter mere labels while they do utter expressive and conative sounds. This is a remarkable fact of human communication and we see its effects at every stage of linguistic development. T h e p r e d o m i n a n t one-word utterances of normal children are, to be sure, nouns or attributes of nouns. But this cannot be construed to mean the early phases of language therapy should deal only with nouns as labels. Clinicians also must a t t e m p t to teach harder-to-picture words such as go and m o r e and even nonpicturable words such as all gone as well. F u r t h e r the child's act 6f labeling probably involves more functionality than its clinical counterpart of simply establishing object-word correspondence. T h e child who labels does so as a self-generated verification task, a memory game, a discovery. Rees 2 suggests that children never utter words in a merely "locutionary sense, but rather that they always have some function, are illocutionary." Clinicians must teach first words in this broader sense so that the therapeutic process might parallel normal language acquisition and that a more semantically and grammatically sound basis of meaning becomes established. Thus, it is not enough to teach the child to say or to recognize go in relationship merely to n a m i n g the behavior of r u n n i n g or of so labeling a picture of a fast moving vehicle; that will accomplish his learning only the referential function. Go must be taught also as an action of his own body, as the act of "making go" a small car across a table, as well as the act of leaving a room, and the more abstract notion of people leaving in contrast with people arriving, and so on. T h e differences may be subtle, b u t subtlety should not obscure their importance. Organicity
Accepting the premise that children should speak "childrenese" in early stages of language therapy has implications for what is talked about as well as for the linguistic form that such talking takes. Clinicians have long been implored to keep a child interested in therapeutic activities, to work at a level appropriate to his age and so on, in what are commendable attempts to deal with a child as a child. But these admonitions do not assure in any way that we have adopted activities that reflect a child's view of his world. It is this writer's belief that much of what we do lacks "organicity," Ashton-Warner's term (1971) for the essential interrelatedness of word and activity and child which is necessary for productive therapeutic interplay. A description of Ashton-Warner's approach to teaching "organic" reading furnishes an example of the experiential quality language clinicians must 2N. S. Rees, personal communication (1975).
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HOLLAND:LanguageTherapy ,517 attempt to replicate in their work. Ashton-Warner developed her techniques for Maori children whose acquaintance with English culture was so limited as to make the English primers then used in New Zealand virtually useless for teaching reading. In the earliest stages the "key" (that is, the relationship between spoken word and graphic representation) is taught. Ashton-Warner asks each child to say five words that are important to him or her. Each word is then written on a separate card and given to the child. Later in the day, she asks each child to "read" his cards. Any word not correctly "read" is removed and another substituted until the child reads his five words on sight correctly, on the ground that the original word lacked the essential organic relationship to the child to have had meaning for reading. These words provide the "key" for subsequently teaching reading. Ashton-Warner assures us that anyone can find five such organic words in any child, but forewarns us that organic words are usually heavily loaded emotionally. For example, she quotes five almost foolproof ones (for speakers of British English at least): m o m m y , d a d d y , kiss, f r i g h t e n e d , ghost.
A principle of organicity is crucial in teaching language to children if communication is the goal. Giddy pleasures, volcanic angers, demons, and monsters are the stuff of childhood. Wants and and the centrality of m e are the fabric of talk, not blue or cup. As Ashton-Warner's reading material is a long trip away from Dick and Jane and Baby Sally, so is an organic approach to speaking a light year removed from "What do you see? .... A tree." or "What is this? .... A ball." If children are to be truly children, and if language is to be truly representative of childhood, it seems necessary to encourage the expression (in language) of frustration, anger, fear, and insecurity, in addition to our present and far more comfortable encouragement of sweetness, light, and good verbal manners. Here and Now Organicity leads directly to the next contextual consideration, that of the psychological tense in which language therapy should be conducted. As Bloom's early work (1970) so eloquently illustrates, understanding what children are saying requires that one understand the environment in which they are saying it. By and large, children speak about the present, with its physical aspects, its emotional features, its ongoing needs all salient. Normal children typically speak in the here and now; language therapy should attempt to replicate this feature of the normal acquisition of speech. Translated into practical clinical terms, the focus on therapy should be on doing and talking about the doing; present-centered "What's happening," instead of past-oriented "What happened." Concentrating in the here and now requires flexibility on the part of the clinician as well as a sensitivity to a child's changing, often mercurial, interests. An illustration perhaps is pertinent. I observed a therapy session in which a gifted clinician was teaching more. She had prepared for the session by
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amassing quantities of similar small items to use in conjunction with her own utterance "more " and had plans eventually to demand the word from the child. However, the child, hyperactive and of limited verbal skills, became fascinated by a box of Kleenex in the room. T h e clinician began pulling tissues from the box, accompanying each pull with her utterance "more Kleenex." Eventually, when clinician and child had scattered tissues around the room the clinician introduced the utterance "more throw," accompanied by the two of them creating a snowfall of tissues. In this manner the child learned more. Concentration in the here and now also has the potential for developing symbolic play skills. Clinicians who commit themselves to present-centered therapy frequently must resort to inventive fantasy when the topic presenting itself is unexpected and not represented by objects considered in advance. Morehead and Ingram (1973) found that language-disordered children had short mean lengths of utterance and also spent less time than normal children in symbolic play activity. A basic relationship exists between all forms of symbolic activities. Opportunities to turn blocks into telephones or toy irons into boats address themselves to symbolization generally and have payoff in symbolic language gains. These sorts of activities are frequently born of necessity, naturally and spontaneously, in therapy sessions; they are difficult to plan for, and well-nigh impossible to confront in any context but the here and now. Communication and Relevant Language
It should be clear by now what I do not consider language to be. W h a t language is is perhaps more obscure. Language is not labeling, or matching pictures to words, or repeating what someone else says. It is instead an active, dynamic, interpersonal interchange and should be treated as such in therapy. Further, while language constitutes a major part of human communication, it is by no means equivalent to h u m a n communication. Therefore, the language clinician must be sensitive to the nature, as well as to the power, of nonlinguistic forms of communication. For language work, it seems entirely reasonable to focus our skills on language that counts as a form of communication. If we successfully teach language that is not useful to the child, we run the risk of inadvertantly teaching the erroneous principle that language is a skill on the order of playing the piano. This helps the child miss the point of communicating and cuts him off as well from the natural consequences of talking that work successfully for normal children as they acquire language. T h e era in which clinicians taught stutterers to enunciate tongue twisters fluently is mercifully long past; but is teaching color names as a language activity so different? Red, as well as Peter Piper picked a peck of pickled peppers, is not the easiest sort of language to work into a conversation. It is important to teach the language-disabled child some language he is likely to use, so that
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HOLLAND:LanguageTherapy 519 the natural rewarding consequences of being understood, granted a request, and so on, can come into play in the real world where poker chips, and candy, and clinical support seldom represent the reinforcing contingencies. It is important to remember that all humans communicate. Even the autistic child communicates eloquently that he wishes not to communicate. Satir (1964) defines communication as a process of sending and receiving information and as a process of making requests of a listener. It seems likely that by age four or so language-disturbed children have begun to perceive themselves as somehow out of this process at the level of verbal communication either as senders or receivers or as both. For language-disturbed children, language is interesting, perhaps, frustrating, probably; but above all language is something in which other people engage, not he. Therefore, language training must be to some very significant extent concerned with helping the child discover his own potential as a verbal communicator. W i t h o u t this discovery, language will remain something akin to a well-practiced talent, a recital, not a new part of him.
Language Therapy as a Communication Microcosm One final contextual consideration concludes this part of the paper. Because language is so pervasive, it is obviously impossible to deal with all situations in which it will be used or to predict the nature of any given linguistic interchange, even at the earliest stages of language usage. Therefore, language therapy should provide a model of the language world to the child and should present him or her with opportunities to participate fully in using that model. T h e simplest means of doing that is by use of a limited size core lexicon in which a significant proportion of the lexical items can function in more than one grammatical slot. T h e core lexicon should be maximally exploitable, maximally generalizable, and have m a x i m u m potential for serving as the basis for later unassisted language growth and use. Once the clinician begins to consider his or her work as representing a microcosm of the language universe, it becomes necessary to choose carefully the representative language to be taught. Simultaneously sharpening the focus and directing the goals for therapy, the clinician is confronted immediately with the fact that not all language is equal in the task of teaching children who have language disorders. THE CONTENT W h a t follows here is an attempt to develop a brief core lexicon in accord with the contextual considerations just outlined and to illustrate how the lexicon can fit into an existing strategy for language therapy. T h e lexicon is not to be viewed as static or rigid; it is intended only as one of many possibilities. T h e lexicon is largely the result of some serious reflection in terms of the content for language therapy. However, a few more formal constraints were
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also applied. T h e first was the r e q u i r e m e n t t h a t the lexicon be relatively short, to illustrate the microcosm context, a n d t h a t it accomplish a q u i c k t r a n s i t i o n f r o m one-word to two-word utterances. T h e r e s u l t i n g lexicon is 35 words. T h e second f o r m a l c o n s t r a i n t was an e x a m i n a t i o n of the first-choice lexicon for its a p p r o p r i a t e n e s s to the psycholinguistically based t h e r a p y models. I n this case it was e x a m i n e d against the models p r o p o s e d by M c D o n a l d a n d Blott (1974) a n d M i l l e r a n d Yoder (1974). Lexical items w h i c h could n o t be c o m b i n e d to p r o d u c e at least five phrases t h a t could be r e l a t e d to at least two semanticg r a m m a t i c a l rules were a r b i t r a r i l y e l i m i n a t e d a n d r e p l a c e d w i t h o t h e r words w h i c h also a p p r o p r i a t e l y reflected the c o n t e x t u a l considerations. T w o words are exceptions to this rule a n d will be discussed. T h e core lexicon a n d the rationales for each w o r d choice are presented. T o assure t h a t n o p r e f e r e n t i a l r a n k o r d e r i n g is implied, words are listed in a helter-skelter fashion w i t h o u t r e g a r d to g r a m m a t i c a l function. 1. Me (or I initially as interchangable equivalents). This word was chosen for frequency of usage in early normal language, and because it is essential if one is ever to learn to include oneself in verbal communication. 2. You. This word was chosen because it greatly simplifies teaching me as it contrasts with it. It is also essential for verbal self-other u~fferentiation. 3. Child's own name. This was chosen because it is essential for self-esteem. (In this case, she's Susie.) 4-6. T h e names of "'significant others" in a given child's life. The arbitrary number was set at three in order to illustrate that there is at least one more than the obvious candidates, Mommy and Daddy. Perhaps it's the family dog, or a brother or sister. This is obviously an expandable lexical category. "Significant others" can be significant for either high-positive or high-negative affect reasons, of course. "Significant others" were chosen for relevance to a child's life. (Here consider Mommy, Daddy, and Fido, the family dog.) 7. Kiss. This word was chosen as an active verb closest to describing a basic emotional condition (love) and because, in this lexicon at least, it is an active affective verb. It relates to the organicity context. 8. Hate. The rationale for kiss applies here. 9. G i m m e (wanna). This word was chosen for several reasons: it relates to a basic or perceived deprivational condition; its use brings a natural environmental contingency into play; it is an active verb; and it is potentially organic. 10. Scared. This word was chosen for organicity. It is also a potential modifying word. 11. Wash. Water play provides an excellent therapeutic environment. Children's early language includes comment on recurring activities. Wash is a verb with recurrent possibilities; hence, its choice here. 12. More. This word was chosen for its frequency of occurrence in normal-child lexicons and for its recurrent possibilities. 13. Go. This word was chosen because it represents a typical child activity and because it is an action verb. 14. No. This word was chosen because of its role in stating nonexistence, rejection, and denial. In communication, it functions as a major step in using language to send and receive information. 15. Yes. The communication role as outlined for no applies here as well. Yes is the major exception to the combining rule previously identified. 16. T h e name of a favorite food. A favorite food name has natural contingency possibilities. It was also chosen for its tangibility. (Here consider Fruitloops).
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HOLLAND: LanguageTherapy 521 17. The name of a least favorite food. The same rationale as for Number 16 applies here. (Here consider pickles). 18. A very angry word. This word was chosen without regard to its combinational possibilities. While it does indeed combine, if carefully chosen, this is quite secondary to its inclusion here. Language deficiency is a profoundly frustrating problem to its owner. It is crucial to be able to express some of the frustration verbally. The ideal choice is the strongest angry word a child's parents can be counseled to tolerate. (Here consider [expletive deleted]). 19. Allgone. This word was chosen for its symbolic play possibilities, for its objectconstancy usage, and for its use with other words in signaling nonexistence verbally. 20. The name of a loved activity. This word should be, preferably, an active word such as throw rather than a passive word such as TV. It was chosen for its relevance to the child's life. 21. Up. This word was chosen to represent activity and positionality, even perhaps simultaneously. It is a simple word to use in action-talking activities. 22. Down. The rationale replicates the rationale for up. 23. There. This word was chosen for its high frequency of occurrence in young children's speech and its locative role in two-word grammars. 24. That. This word was chosen for frequency of occurrence and for usefulness in combining. 25. Hi. When spoken to, most people respond. This word was chosen to assure verbal interaction and to teach the child that he can be noticed verbally. 26. My (mine). This word was chosen for early introduction of possession. 27. Your. The same rationale as for my applies here. Note that both also strengthen self-other differentiation. T h e final words in this lexicon are possibly m o r e r e p r e s e n t a t i v e of clinically a p p r o p r i a t e l a n g u a g e e n v i r o n m e n t s t h a n of core lexical words. T h e y grew o u t of linguistic c o m b i n a t i o n possibilities p r i m a r i l y , a n d clinical good sense secondarily. I n short, these words r e p r e s e n t classes of t r a d i t i o n a l clinical activities a n d clinical a c c o u t r e m e n t s and, as lexical terms, are even less sacrosanct t h a n those a l r e a d y listed. T h e y are: 28-29. Big and little. These words are here for combinational, perceptual, conceptual, and cognitive reasons. 30-32. Ball, block, and car. Ball playing and building with big blocks and car going are excellent big-motor activities for clinical language use. Thus it seems natural to teach their names here. 33. Beads. In various sizes and shapes, beads are clinically useful for teaching size differentiation and linguistic recurrence. It again seems natural to teach their name. 34. Doll or stuffed cuddly toy. Who could be a clinician without at least one of them? Might as well teach their names. (Here consider Dolly). 35. Clinician's name. This name is included here to ensure active role in therapy. (In this case consider Audrey). T o conclude the illustration, the A p p e n d i x summarizes the a p p l i c a t i o n of this core lexicon to M c D o n a l d a n d Blott's model. A t least two e x a m p l e s for each of t h e i r s e m a n t i c - g r a m m a t i c a l rules are p r o v i d e d in a n a t t e m p t to illustrate child, r a t h e r t h a n adult, g r a m m a t i c a l categories. It s h o u l d be n o t e d t h a t m a n y m o r e such u t t e r a n c e s can be g e n e r a t e d f r o m this d e l i b e r a t e l y c u r t a i l e d lexicon t h a n are i n d i c a t e d in the A p p e n d i x .
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CONCLUSIONS T h e i n t e n t of this p a p e r has b e e n to i n d i c a t e some areas of i m p o r t a n c e to speech clinicians w h i c h m u s t be considered if one is to successfully a p p l y p s y c h o l i n g u i s t i c strategies to c h i l d r e n w i t h l a n g u a g e disorders. It is by n o m e a n s an e x h a u s t i v e g r o u p of general considerations, m e r e l y some i n i t i a l thoughts w h i c h m i g h t serve to alert clinicians to m o r e careful control of context a n d content i n their therapy. It is likely that some areas have b e e n ignored t h r o u g h ignorance of t h e i r i m p o r t a n c e . Others, such as the necessity to teach c o m p r e h e n s i o n before production, have b e e n i g n o r e d because they a p p e a r w i t h clarity a n d f r e q u e n c y i n the l i t e r a t u r e of psycholinguistics a p p l i e d to language-disordered children. Still others have been ignored because the a u t h o r is so u n s u r e of the answers; for e x a m p l e , the n a t u r e of the l a n g u a g e s t i m u l i good clinicians s h o u l d furnish. S h o u l d they speak "childrenese," or s h o u l d they e x p a n d a n d reduce a n d provide m o d e l s (expatiate) i n t h e i r most sensitive a n d n a t u r a l way? It seems a p p r o p r i a t e to e n d this conjectural essay w i t h a s t a n d a r d p l e a for more d e t a i l e d clinical reports a n d more e m p i r i c a l investigation into the course of l a n g u a g e therapy.
ACKNOWLEDGMENT The author is indebted to Anne M. Shoben for her editorial insights in preparing this manuscript, to Norma S. Rees for her encouragement, and to Barbara Kozbelt-Culatta whose clinical insights and skills motivated this paper. Requests for reprints should be addressed to Audrey Holland, Speech Department, University of Pittsburgh, Pittsburgh, Pennsylvania 15260.
REFERENCES ASHTON-WARNER, S., Teacher. New York: Bantam (1971).
BLOOM, L., Language Development: Form and Function in Emerging Grammars. Cambridge, Mass.: MIT Press (1970). BRICKER, W. A., and BRICKER, n. D., An early language training strategy. In R. L. Schiefelbusch and L. L. Lloyd (Eds.), Language Perspectives: Acquisition, Retardation and Intervention. Baltimore: University Park (1974). BROWN, R., A First Language. Cambridge: Harvard Univ. Press (1973). DALE, P., Language Development. Hinsdale, Ill.: Dryden (1972). MCDONALD, J. D., and BLOTr, J. P., Environmental language intervention: The rationale for a diagnostic and training strategy through rules, context, and generalization. J. Speech Hearing Dis., 39, 244-256 (1974). McNEmL, D., The capacity for language acquisition. Volta Rev., 68: 1, 17-33 (1966). McNEmL, D., The Acquisition o] Language: The Study o] Developmental Psycholinguistics. New York: Harper and Row (1970). MILLER, J., and YODER,D., An ontogenetic language teaching strategy for retarded children. In R. L. Schiefelbusch and L. L. Lloyd (Eds.), Language Perspectives: Acquisition, Retardation and Intervention. Baltimore: University Park (1974). MO~HE~D, D., and INGmM, D., The development of base syntax in normal and linguistically deviant children. ]. Speech Hearing Res., 16, 330-352 (1973). SATIn, V., Conjoint Family Therapy. Palo Alto, Calif.: Science and Behavior (1964). SCmEt~ZLBUSCH,R. L., and LLOYD,L. L. (Eds.), Language Perspectives: Acquisition, Retardation and Intervention. Baltimore: University Park (1974). Received February 14, 1975. Accepted April 9, 1975.
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HOLLAND: Language Therapy 523 APPENDIX
Examples of McDonald and Blott's Early Language Intervention Strategy with proposed content model. Semantic-Grammatical Rules (SG rules)
Illustration from Proposed Content
1. Agent + Action
carFruitl~176 go
meDolly,1kiss
2. Action + Object
gimme Ibel? s
wash
3. Agent + Object
~Fruitloops Susie ~Kitty
Mommy ~Pickles
As in Susie is
4. X + Locative a. entity + locative b. action + locative 5. Negation + X a. nonexistence b. rejection
c. denial
fbloll k
~rido
eating Fruitloops. or Susie sees the Kitty.
As in Mommy is petting Fido. Mommy takes the pickles.
You I there (up
car block As in The car is on the block.
~down throw ~there no Dolly allgone Fruitloops As when it isn't As in I just finished where it's expected, them. hate pickles As in I don't want
allgone Audrey As in Go away,
any.
Audrey.
no
~scared ~block
As in I'm not scared. As in that's a bead, not a block. 6. Modifier and Head a. attribution
big
SSusie ~throw
letter
~block ~ball
my
~Fido ~Daddy
your
~bead ~Dolly
more
~kiss ~Fruitloops
Hi
~bead ~Audrey
kiss
{me Dolly
b. possession c. recurrence 7. Introducer + X 8. X -t- Dative
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Audrey L. Holland University of Pittsburgh, Pennsylvania
A presentation of ideas on the ideal context for language therapy for children, this paper explores in detail the importance of teaching child language, centering language therapy in the present, teaching words with empirical significance to the child, attempting to provide a language context which is generative to unassisted later language learning, and, finally, teaching communication, not merely language skills. In addition a sample core lexicon is presented which was designed to relate the above contextual aspects of therapy to psycholinguistic strategies of language therapy.
Speech pathologists whose major interest is in developing language in languagedisordered children are presently in an excellent position to increase the effectiveness of their work. A burgeoning literature on normal language development is becoming available; and psychologists and speech pathologists with a psycholinguistic, as well as a behavioral frame of reference, are developing strategies at an astonishingly rapid rate for applying that literature to children with atypical language development. In the past year alone, for example, at least three such strategies, all appearing to be carefully reasoned and conceptually sound, have appeared in the literature (Bricker and Bricker, 1974; Miller and Yoder, 1974; McDonald and Blott, 1974). Clinicians who wish to use these or other psycholinguistically based strategies face a problem not unlike the child who is the subject of the exploding literature. They are required to sift these approaches through the filters of their perceptions and information and learn a new lexicon. They must, as language-learning children do, develop hypotheses about how the system works and subject those hypotheses to validation by trying them out in controlled and principled ways. Language clinicians appear to be grappling successfully with psycholinguistics in its broadest application to speech pathology, as the data presented by Bricker and Bricker, Miller and Yoder, and McDonald and Blott in the above-referenced works suggest that more children are learning more language. However, our success has uncovered a new set of quite intriguing concerns. Now that we have a clearer idea of what we are doing, how can we do it more parsimoniously? How can we ensure that the language taught in clinic or classroom will be of use to the child in his natural environment? T h e author be514
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HOLLAND:LanguageTherapy 515 lieves that answers to these questions can be sought most fruitfully in the clinical context and in the semantic content of language therapy. Context is used here with its standard meaning, that of the interrelated environmental conditions in which language therapy takes place; content simply refers to the words focused on in therapy. This paper is addressed to those two areas, context and content, as they might be manipulated for richer gains in language therapy. T h e first part of the paper discusses five contextual matters which appear to this writer to be critical for an effective, psycholinguistically based language therapy. T h e second part presents an example of a core lexicon compatible with the contexts described in the first part and the rationales for each word chosen. Diagnostic categories of language disorders are ignored in this paper because I am convinced that the context and content described are relevant to all language disorders. There may well be many other contexts specific to braindamaged children, hearing-impaired children, and mentally retarded children, but they are outside the purview of this paper. THE CONTEXT
Learning Childrenese Some years ago, McNeil1 (1966) noted with bewilderment that adult grammar was used in teaching deaf children and, in turn, was expected of them. Reasoning that normal children do not learn a few words and then start stringing them together as adults do, he found it difficult to comprehend our expectations that children with the kind of profound language problems deafness engenders could do so. If we accept a developmental psycholinguistic frame of reference, McNeill's objections can be addressed at least as far as grammar is concerned. By definition, developmental models for therapy teach child, not adult, grammar. 1 Since psycholinguistic strategies for work with children begin with early grammatical forms, the clinician who attempts to use them still must make psycholinguistic decisions about teaching single words that combine into a rudimentary grammar. Thus the clinician must consider carefully the function of one-word utterances in children's speech. Earliest single-word utterances are not necessarily labels but also can connote far more complex ideas. For example, the word water does not always simply refer to the liquid in question, but probably means the child wants some, or that he is in some, or has made some, or that his mother is to look at some, or even some meaning not apparent on first hearing to the adult involved. In this sense, one-word utterances are holophrastic in nature. In relit behooves the clinician using the models to assimilate the work on which these models are based, of course. Three recommended texts are: R. Brown, A First Language (1973); P. Dale, Language Development (1972); and R. Schiefelbusch and L. Lloyd (Eds.), Language Perspective: Acquisition, Retardation and Intervention (1974).
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viewing the literature on holophrastic speech, McNeill (1970, p. 23) points out that: Children never utter mere labels while they do utter expressive and conative sounds. This is a remarkable fact of human communication and we see its effects at every stage of linguistic development. T h e p r e d o m i n a n t one-word utterances of normal children are, to be sure, nouns or attributes of nouns. But this cannot be construed to mean the early phases of language therapy should deal only with nouns as labels. Clinicians also must a t t e m p t to teach harder-to-picture words such as go and m o r e and even nonpicturable words such as all gone as well. F u r t h e r the child's act 6f labeling probably involves more functionality than its clinical counterpart of simply establishing object-word correspondence. T h e child who labels does so as a self-generated verification task, a memory game, a discovery. Rees 2 suggests that children never utter words in a merely "locutionary sense, but rather that they always have some function, are illocutionary." Clinicians must teach first words in this broader sense so that the therapeutic process might parallel normal language acquisition and that a more semantically and grammatically sound basis of meaning becomes established. Thus, it is not enough to teach the child to say or to recognize go in relationship merely to n a m i n g the behavior of r u n n i n g or of so labeling a picture of a fast moving vehicle; that will accomplish his learning only the referential function. Go must be taught also as an action of his own body, as the act of "making go" a small car across a table, as well as the act of leaving a room, and the more abstract notion of people leaving in contrast with people arriving, and so on. T h e differences may be subtle, b u t subtlety should not obscure their importance. Organicity
Accepting the premise that children should speak "childrenese" in early stages of language therapy has implications for what is talked about as well as for the linguistic form that such talking takes. Clinicians have long been implored to keep a child interested in therapeutic activities, to work at a level appropriate to his age and so on, in what are commendable attempts to deal with a child as a child. But these admonitions do not assure in any way that we have adopted activities that reflect a child's view of his world. It is this writer's belief that much of what we do lacks "organicity," Ashton-Warner's term (1971) for the essential interrelatedness of word and activity and child which is necessary for productive therapeutic interplay. A description of Ashton-Warner's approach to teaching "organic" reading furnishes an example of the experiential quality language clinicians must 2N. S. Rees, personal communication (1975).
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HOLLAND:LanguageTherapy ,517 attempt to replicate in their work. Ashton-Warner developed her techniques for Maori children whose acquaintance with English culture was so limited as to make the English primers then used in New Zealand virtually useless for teaching reading. In the earliest stages the "key" (that is, the relationship between spoken word and graphic representation) is taught. Ashton-Warner asks each child to say five words that are important to him or her. Each word is then written on a separate card and given to the child. Later in the day, she asks each child to "read" his cards. Any word not correctly "read" is removed and another substituted until the child reads his five words on sight correctly, on the ground that the original word lacked the essential organic relationship to the child to have had meaning for reading. These words provide the "key" for subsequently teaching reading. Ashton-Warner assures us that anyone can find five such organic words in any child, but forewarns us that organic words are usually heavily loaded emotionally. For example, she quotes five almost foolproof ones (for speakers of British English at least): m o m m y , d a d d y , kiss, f r i g h t e n e d , ghost.
A principle of organicity is crucial in teaching language to children if communication is the goal. Giddy pleasures, volcanic angers, demons, and monsters are the stuff of childhood. Wants and and the centrality of m e are the fabric of talk, not blue or cup. As Ashton-Warner's reading material is a long trip away from Dick and Jane and Baby Sally, so is an organic approach to speaking a light year removed from "What do you see? .... A tree." or "What is this? .... A ball." If children are to be truly children, and if language is to be truly representative of childhood, it seems necessary to encourage the expression (in language) of frustration, anger, fear, and insecurity, in addition to our present and far more comfortable encouragement of sweetness, light, and good verbal manners. Here and Now Organicity leads directly to the next contextual consideration, that of the psychological tense in which language therapy should be conducted. As Bloom's early work (1970) so eloquently illustrates, understanding what children are saying requires that one understand the environment in which they are saying it. By and large, children speak about the present, with its physical aspects, its emotional features, its ongoing needs all salient. Normal children typically speak in the here and now; language therapy should attempt to replicate this feature of the normal acquisition of speech. Translated into practical clinical terms, the focus on therapy should be on doing and talking about the doing; present-centered "What's happening," instead of past-oriented "What happened." Concentrating in the here and now requires flexibility on the part of the clinician as well as a sensitivity to a child's changing, often mercurial, interests. An illustration perhaps is pertinent. I observed a therapy session in which a gifted clinician was teaching more. She had prepared for the session by
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amassing quantities of similar small items to use in conjunction with her own utterance "more " and had plans eventually to demand the word from the child. However, the child, hyperactive and of limited verbal skills, became fascinated by a box of Kleenex in the room. T h e clinician began pulling tissues from the box, accompanying each pull with her utterance "more Kleenex." Eventually, when clinician and child had scattered tissues around the room the clinician introduced the utterance "more throw," accompanied by the two of them creating a snowfall of tissues. In this manner the child learned more. Concentration in the here and now also has the potential for developing symbolic play skills. Clinicians who commit themselves to present-centered therapy frequently must resort to inventive fantasy when the topic presenting itself is unexpected and not represented by objects considered in advance. Morehead and Ingram (1973) found that language-disordered children had short mean lengths of utterance and also spent less time than normal children in symbolic play activity. A basic relationship exists between all forms of symbolic activities. Opportunities to turn blocks into telephones or toy irons into boats address themselves to symbolization generally and have payoff in symbolic language gains. These sorts of activities are frequently born of necessity, naturally and spontaneously, in therapy sessions; they are difficult to plan for, and well-nigh impossible to confront in any context but the here and now. Communication and Relevant Language
It should be clear by now what I do not consider language to be. W h a t language is is perhaps more obscure. Language is not labeling, or matching pictures to words, or repeating what someone else says. It is instead an active, dynamic, interpersonal interchange and should be treated as such in therapy. Further, while language constitutes a major part of human communication, it is by no means equivalent to h u m a n communication. Therefore, the language clinician must be sensitive to the nature, as well as to the power, of nonlinguistic forms of communication. For language work, it seems entirely reasonable to focus our skills on language that counts as a form of communication. If we successfully teach language that is not useful to the child, we run the risk of inadvertantly teaching the erroneous principle that language is a skill on the order of playing the piano. This helps the child miss the point of communicating and cuts him off as well from the natural consequences of talking that work successfully for normal children as they acquire language. T h e era in which clinicians taught stutterers to enunciate tongue twisters fluently is mercifully long past; but is teaching color names as a language activity so different? Red, as well as Peter Piper picked a peck of pickled peppers, is not the easiest sort of language to work into a conversation. It is important to teach the language-disabled child some language he is likely to use, so that
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HOLLAND:LanguageTherapy 519 the natural rewarding consequences of being understood, granted a request, and so on, can come into play in the real world where poker chips, and candy, and clinical support seldom represent the reinforcing contingencies. It is important to remember that all humans communicate. Even the autistic child communicates eloquently that he wishes not to communicate. Satir (1964) defines communication as a process of sending and receiving information and as a process of making requests of a listener. It seems likely that by age four or so language-disturbed children have begun to perceive themselves as somehow out of this process at the level of verbal communication either as senders or receivers or as both. For language-disturbed children, language is interesting, perhaps, frustrating, probably; but above all language is something in which other people engage, not he. Therefore, language training must be to some very significant extent concerned with helping the child discover his own potential as a verbal communicator. W i t h o u t this discovery, language will remain something akin to a well-practiced talent, a recital, not a new part of him.
Language Therapy as a Communication Microcosm One final contextual consideration concludes this part of the paper. Because language is so pervasive, it is obviously impossible to deal with all situations in which it will be used or to predict the nature of any given linguistic interchange, even at the earliest stages of language usage. Therefore, language therapy should provide a model of the language world to the child and should present him or her with opportunities to participate fully in using that model. T h e simplest means of doing that is by use of a limited size core lexicon in which a significant proportion of the lexical items can function in more than one grammatical slot. T h e core lexicon should be maximally exploitable, maximally generalizable, and have m a x i m u m potential for serving as the basis for later unassisted language growth and use. Once the clinician begins to consider his or her work as representing a microcosm of the language universe, it becomes necessary to choose carefully the representative language to be taught. Simultaneously sharpening the focus and directing the goals for therapy, the clinician is confronted immediately with the fact that not all language is equal in the task of teaching children who have language disorders. THE CONTENT W h a t follows here is an attempt to develop a brief core lexicon in accord with the contextual considerations just outlined and to illustrate how the lexicon can fit into an existing strategy for language therapy. T h e lexicon is not to be viewed as static or rigid; it is intended only as one of many possibilities. T h e lexicon is largely the result of some serious reflection in terms of the content for language therapy. However, a few more formal constraints were
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also applied. T h e first was the r e q u i r e m e n t t h a t the lexicon be relatively short, to illustrate the microcosm context, a n d t h a t it accomplish a q u i c k t r a n s i t i o n f r o m one-word to two-word utterances. T h e r e s u l t i n g lexicon is 35 words. T h e second f o r m a l c o n s t r a i n t was an e x a m i n a t i o n of the first-choice lexicon for its a p p r o p r i a t e n e s s to the psycholinguistically based t h e r a p y models. I n this case it was e x a m i n e d against the models p r o p o s e d by M c D o n a l d a n d Blott (1974) a n d M i l l e r a n d Yoder (1974). Lexical items w h i c h could n o t be c o m b i n e d to p r o d u c e at least five phrases t h a t could be r e l a t e d to at least two semanticg r a m m a t i c a l rules were a r b i t r a r i l y e l i m i n a t e d a n d r e p l a c e d w i t h o t h e r words w h i c h also a p p r o p r i a t e l y reflected the c o n t e x t u a l considerations. T w o words are exceptions to this rule a n d will be discussed. T h e core lexicon a n d the rationales for each w o r d choice are presented. T o assure t h a t n o p r e f e r e n t i a l r a n k o r d e r i n g is implied, words are listed in a helter-skelter fashion w i t h o u t r e g a r d to g r a m m a t i c a l function. 1. Me (or I initially as interchangable equivalents). This word was chosen for frequency of usage in early normal language, and because it is essential if one is ever to learn to include oneself in verbal communication. 2. You. This word was chosen because it greatly simplifies teaching me as it contrasts with it. It is also essential for verbal self-other u~fferentiation. 3. Child's own name. This was chosen because it is essential for self-esteem. (In this case, she's Susie.) 4-6. T h e names of "'significant others" in a given child's life. The arbitrary number was set at three in order to illustrate that there is at least one more than the obvious candidates, Mommy and Daddy. Perhaps it's the family dog, or a brother or sister. This is obviously an expandable lexical category. "Significant others" can be significant for either high-positive or high-negative affect reasons, of course. "Significant others" were chosen for relevance to a child's life. (Here consider Mommy, Daddy, and Fido, the family dog.) 7. Kiss. This word was chosen as an active verb closest to describing a basic emotional condition (love) and because, in this lexicon at least, it is an active affective verb. It relates to the organicity context. 8. Hate. The rationale for kiss applies here. 9. G i m m e (wanna). This word was chosen for several reasons: it relates to a basic or perceived deprivational condition; its use brings a natural environmental contingency into play; it is an active verb; and it is potentially organic. 10. Scared. This word was chosen for organicity. It is also a potential modifying word. 11. Wash. Water play provides an excellent therapeutic environment. Children's early language includes comment on recurring activities. Wash is a verb with recurrent possibilities; hence, its choice here. 12. More. This word was chosen for its frequency of occurrence in normal-child lexicons and for its recurrent possibilities. 13. Go. This word was chosen because it represents a typical child activity and because it is an action verb. 14. No. This word was chosen because of its role in stating nonexistence, rejection, and denial. In communication, it functions as a major step in using language to send and receive information. 15. Yes. The communication role as outlined for no applies here as well. Yes is the major exception to the combining rule previously identified. 16. T h e name of a favorite food. A favorite food name has natural contingency possibilities. It was also chosen for its tangibility. (Here consider Fruitloops).
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HOLLAND: LanguageTherapy 521 17. The name of a least favorite food. The same rationale as for Number 16 applies here. (Here consider pickles). 18. A very angry word. This word was chosen without regard to its combinational possibilities. While it does indeed combine, if carefully chosen, this is quite secondary to its inclusion here. Language deficiency is a profoundly frustrating problem to its owner. It is crucial to be able to express some of the frustration verbally. The ideal choice is the strongest angry word a child's parents can be counseled to tolerate. (Here consider [expletive deleted]). 19. Allgone. This word was chosen for its symbolic play possibilities, for its objectconstancy usage, and for its use with other words in signaling nonexistence verbally. 20. The name of a loved activity. This word should be, preferably, an active word such as throw rather than a passive word such as TV. It was chosen for its relevance to the child's life. 21. Up. This word was chosen to represent activity and positionality, even perhaps simultaneously. It is a simple word to use in action-talking activities. 22. Down. The rationale replicates the rationale for up. 23. There. This word was chosen for its high frequency of occurrence in young children's speech and its locative role in two-word grammars. 24. That. This word was chosen for frequency of occurrence and for usefulness in combining. 25. Hi. When spoken to, most people respond. This word was chosen to assure verbal interaction and to teach the child that he can be noticed verbally. 26. My (mine). This word was chosen for early introduction of possession. 27. Your. The same rationale as for my applies here. Note that both also strengthen self-other differentiation. T h e final words in this lexicon are possibly m o r e r e p r e s e n t a t i v e of clinically a p p r o p r i a t e l a n g u a g e e n v i r o n m e n t s t h a n of core lexical words. T h e y grew o u t of linguistic c o m b i n a t i o n possibilities p r i m a r i l y , a n d clinical good sense secondarily. I n short, these words r e p r e s e n t classes of t r a d i t i o n a l clinical activities a n d clinical a c c o u t r e m e n t s and, as lexical terms, are even less sacrosanct t h a n those a l r e a d y listed. T h e y are: 28-29. Big and little. These words are here for combinational, perceptual, conceptual, and cognitive reasons. 30-32. Ball, block, and car. Ball playing and building with big blocks and car going are excellent big-motor activities for clinical language use. Thus it seems natural to teach their names here. 33. Beads. In various sizes and shapes, beads are clinically useful for teaching size differentiation and linguistic recurrence. It again seems natural to teach their name. 34. Doll or stuffed cuddly toy. Who could be a clinician without at least one of them? Might as well teach their names. (Here consider Dolly). 35. Clinician's name. This name is included here to ensure active role in therapy. (In this case consider Audrey). T o conclude the illustration, the A p p e n d i x summarizes the a p p l i c a t i o n of this core lexicon to M c D o n a l d a n d Blott's model. A t least two e x a m p l e s for each of t h e i r s e m a n t i c - g r a m m a t i c a l rules are p r o v i d e d in a n a t t e m p t to illustrate child, r a t h e r t h a n adult, g r a m m a t i c a l categories. It s h o u l d be n o t e d t h a t m a n y m o r e such u t t e r a n c e s can be g e n e r a t e d f r o m this d e l i b e r a t e l y c u r t a i l e d lexicon t h a n are i n d i c a t e d in the A p p e n d i x .
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CONCLUSIONS T h e i n t e n t of this p a p e r has b e e n to i n d i c a t e some areas of i m p o r t a n c e to speech clinicians w h i c h m u s t be considered if one is to successfully a p p l y p s y c h o l i n g u i s t i c strategies to c h i l d r e n w i t h l a n g u a g e disorders. It is by n o m e a n s an e x h a u s t i v e g r o u p of general considerations, m e r e l y some i n i t i a l thoughts w h i c h m i g h t serve to alert clinicians to m o r e careful control of context a n d content i n their therapy. It is likely that some areas have b e e n ignored t h r o u g h ignorance of t h e i r i m p o r t a n c e . Others, such as the necessity to teach c o m p r e h e n s i o n before production, have b e e n i g n o r e d because they a p p e a r w i t h clarity a n d f r e q u e n c y i n the l i t e r a t u r e of psycholinguistics a p p l i e d to language-disordered children. Still others have been ignored because the a u t h o r is so u n s u r e of the answers; for e x a m p l e , the n a t u r e of the l a n g u a g e s t i m u l i good clinicians s h o u l d furnish. S h o u l d they speak "childrenese," or s h o u l d they e x p a n d a n d reduce a n d provide m o d e l s (expatiate) i n t h e i r most sensitive a n d n a t u r a l way? It seems a p p r o p r i a t e to e n d this conjectural essay w i t h a s t a n d a r d p l e a for more d e t a i l e d clinical reports a n d more e m p i r i c a l investigation into the course of l a n g u a g e therapy.
ACKNOWLEDGMENT The author is indebted to Anne M. Shoben for her editorial insights in preparing this manuscript, to Norma S. Rees for her encouragement, and to Barbara Kozbelt-Culatta whose clinical insights and skills motivated this paper. Requests for reprints should be addressed to Audrey Holland, Speech Department, University of Pittsburgh, Pittsburgh, Pennsylvania 15260.
REFERENCES ASHTON-WARNER, S., Teacher. New York: Bantam (1971).
BLOOM, L., Language Development: Form and Function in Emerging Grammars. Cambridge, Mass.: MIT Press (1970). BRICKER, W. A., and BRICKER, n. D., An early language training strategy. In R. L. Schiefelbusch and L. L. Lloyd (Eds.), Language Perspectives: Acquisition, Retardation and Intervention. Baltimore: University Park (1974). BROWN, R., A First Language. Cambridge: Harvard Univ. Press (1973). DALE, P., Language Development. Hinsdale, Ill.: Dryden (1972). MCDONALD, J. D., and BLOTr, J. P., Environmental language intervention: The rationale for a diagnostic and training strategy through rules, context, and generalization. J. Speech Hearing Dis., 39, 244-256 (1974). McNEmL, D., The capacity for language acquisition. Volta Rev., 68: 1, 17-33 (1966). McNEmL, D., The Acquisition o] Language: The Study o] Developmental Psycholinguistics. New York: Harper and Row (1970). MILLER, J., and YODER,D., An ontogenetic language teaching strategy for retarded children. In R. L. Schiefelbusch and L. L. Lloyd (Eds.), Language Perspectives: Acquisition, Retardation and Intervention. Baltimore: University Park (1974). MO~HE~D, D., and INGmM, D., The development of base syntax in normal and linguistically deviant children. ]. Speech Hearing Res., 16, 330-352 (1973). SATIn, V., Conjoint Family Therapy. Palo Alto, Calif.: Science and Behavior (1964). SCmEt~ZLBUSCH,R. L., and LLOYD,L. L. (Eds.), Language Perspectives: Acquisition, Retardation and Intervention. Baltimore: University Park (1974). Received February 14, 1975. Accepted April 9, 1975.
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HOLLAND: Language Therapy 523 APPENDIX
Examples of McDonald and Blott's Early Language Intervention Strategy with proposed content model. Semantic-Grammatical Rules (SG rules)
Illustration from Proposed Content
1. Agent + Action
carFruitl~176 go
meDolly,1kiss
2. Action + Object
gimme Ibel? s
wash
3. Agent + Object
~Fruitloops Susie ~Kitty
Mommy ~Pickles
As in Susie is
4. X + Locative a. entity + locative b. action + locative 5. Negation + X a. nonexistence b. rejection
c. denial
fbloll k
~rido
eating Fruitloops. or Susie sees the Kitty.
As in Mommy is petting Fido. Mommy takes the pickles.
You I there (up
car block As in The car is on the block.
~down throw ~there no Dolly allgone Fruitloops As when it isn't As in I just finished where it's expected, them. hate pickles As in I don't want
allgone Audrey As in Go away,
any.
Audrey.
no
~scared ~block
As in I'm not scared. As in that's a bead, not a block. 6. Modifier and Head a. attribution
big
SSusie ~throw
letter
~block ~ball
my
~Fido ~Daddy
your
~bead ~Dolly
more
~kiss ~Fruitloops
Hi
~bead ~Audrey
kiss
{me Dolly
b. possession c. recurrence 7. Introducer + X 8. X -t- Dative
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