Develop, Med. Child Neurol. 1975, 17,400-402
Letters to the Editor The Language Disordered Child SIR-In response to Dr. Mac Keith’s plea for information concerning the ideas on auditory perception and speech expressed in the book by Fraser and Blockley (DMCN, 16,840-841), I wonder whether you would find the following comments to be of interest. They are made from the point of view of a linguist only. Fraser and Blockley take the view that the underlying cause of language disability is a defective appreciation of relationships of space and time; and that if this is attacked and improved, language proficiency will improve as a natural consequence. While the hypothesis is not implausible, the “comprehensive and coherent theory of perception” which the authors seek (p. 40) does not exist: as they themselves say-“We do not know enough about the normal development of perception to be able to devise a programme, let alone how it would apply in the case of the perceptually disordered child” (p. 43). I accept that if there is perceptual disability, then this must be attacked before comprehension and production of speech is likely to develop normally. But the implementation of Fraser and Blockley’s theory involves contradictory linguistic considerations, the status of language in their methodology is unclear, and their analysis of language behaviour contains misleading assumptions, when looked at from the point of view of linguistics. Concerning their theoretical position, they claim that their work is based on a study of the literature on language over the past 200 years; but they refer only t o the more speculative, philosophical writings-no technical works of contemporary linguistics are referred to at all. What they produce, in fact, is an amalgam of linguistic notions from different theories and stages of development within theories, which inevitably is inconsistent. On the one hand, they say their work is close to a Piagetian psycholinguistic view of language as an internal part of cognitive activity and development (p. 52); on the other hand, their entire discussion is couched in generative linguistic terms which are, in the last resort, fundamentally incompatible with Piagetian theory. Then within generative grammar, 1957 notions of kernel sentences are made to exist alongside 1965 notions of transformation and 1970 conceptions of deep structure in terms of generative semantics. As a result, the basic claims of their approach remain quite obscure, e.g. that their programme is “based on the theory that the remedying of the child’s perceptual disorder enables him to relate the surface structure of speech to the deep structure” (p. 26). Concerning methodology, the authors provide little detail about the r61e of language in their work. They claim that their approach is non-verbal, that is “we do not treat through the defective medium” (p. 51). But the one child they give us a detailed account of had had considerable language contact and therapy before their programme started, and it is left quite unclear, in the discussion of the visual and auditory sequencing tasks which constitute part of the programme, how much and what kind of language was used to the boy or around him in the instructions and discussion of the tasks (pp. 22-23). It seems unlikely 400
LETTERS TO THE EDITOR
that the programme was carried through in complete silence, and no account seems to be taken of the language contact he was receiving out3ide the clinic, where he was being seen for one hour each day. In this respect, attributing the improvement obtained to the perceptual hypothesis seems premature. They put the questions: ‘Is it reasonable that the medium of remedial education should be the one in which his disability lies? Can a disorder of language be remedied by repetitive practice in the medium of language?‘ (p. 36), to which they clearly anticipate the answer ‘Nu’. But a better answer is ‘It depends’, as the questions contain an assumption which linguists would argue is incorrect, namely that language is a single, homogeneous structure. If one takes the view that there are levels of syntactic structure, however, then it is perfectly feasible to concentrate on certain aspects of syntax while ignoring others, right from the beginning of syntactic development. This book does not dissuade me from my belief that linguistic reasoning and technique provide an indispensable element of any remedial procedure in this area. D. CRYSTAL Faculty of Letters and Social Sciences, University of Reading, Whiteknights, Reading RG6 2AA.
Multiple Cranial Nerve Palsies and the Arnold-Chiari Malformation SIR-Dr. Venes’ review of the literature on the multiple cranial nerve palsies associated with Arnold-Chiari malformation ( D M C N , 16, 817) revealed only a single reported case. I would like to add four cases which we reported’, in addition to the five we found in the literature at the time of our review. ROBERTL. SIEBEN 2425 East Street, Concord, California 94520. Sieben. R. L., Hamidam, N. B., Shulman, K . (1971) ‘Multiple cranial nerve deficits associated with the Arnold-Chiari malformation.’ Neurology, 21, 673.
‘Unilateral Nerve Deafness in Childhood’ SIR-Snead et al. ( D M C N , 17, 84) reported a case of unilateral sensorineural deafness due to possible vascular pathology in a child. The description of the audiological data was confusing. They stated that the child had normal hearing on the right and a sensorineural hearing loss on the left. This is consistent with the audiogram presented in Figure I. However, they further state that the Bekesy audiometry showed a 92 per cent tone discrimination on the right and a 46 per cent tone discrimination with no tone decay on the left (Type I). The Bekesy audiometer is an audiomatic audiometer, which allows the patient to plot his own threshold. The end result is an audiogram, not any measure of tone discrimination. The only task of discrimination involved is that of detecting the presence of sound versus no sound. I suspect that the percentages the authors report as tone discrimination represent speech discrimination scores, since they also occur in Figure I and no reference to them is made in the text. The fact that this child had a normal speech reception threshold and poor speech discrimination (46 per cent) on the affected side is a very significant finding that should be pointed out. Poor speech discrimination, with high-frequency hearing loss starting at 2000Hz, is consistent with vascular induced hearing loss. Again, referring 40 I
Letters to the Editor The Language Disordered Child SIR-In response to Dr. Mac Keith’s plea for information concerning the ideas on auditory perception and speech expressed in the book by Fraser and Blockley (DMCN, 16,840-841), I wonder whether you would find the following comments to be of interest. They are made from the point of view of a linguist only. Fraser and Blockley take the view that the underlying cause of language disability is a defective appreciation of relationships of space and time; and that if this is attacked and improved, language proficiency will improve as a natural consequence. While the hypothesis is not implausible, the “comprehensive and coherent theory of perception” which the authors seek (p. 40) does not exist: as they themselves say-“We do not know enough about the normal development of perception to be able to devise a programme, let alone how it would apply in the case of the perceptually disordered child” (p. 43). I accept that if there is perceptual disability, then this must be attacked before comprehension and production of speech is likely to develop normally. But the implementation of Fraser and Blockley’s theory involves contradictory linguistic considerations, the status of language in their methodology is unclear, and their analysis of language behaviour contains misleading assumptions, when looked at from the point of view of linguistics. Concerning their theoretical position, they claim that their work is based on a study of the literature on language over the past 200 years; but they refer only t o the more speculative, philosophical writings-no technical works of contemporary linguistics are referred to at all. What they produce, in fact, is an amalgam of linguistic notions from different theories and stages of development within theories, which inevitably is inconsistent. On the one hand, they say their work is close to a Piagetian psycholinguistic view of language as an internal part of cognitive activity and development (p. 52); on the other hand, their entire discussion is couched in generative linguistic terms which are, in the last resort, fundamentally incompatible with Piagetian theory. Then within generative grammar, 1957 notions of kernel sentences are made to exist alongside 1965 notions of transformation and 1970 conceptions of deep structure in terms of generative semantics. As a result, the basic claims of their approach remain quite obscure, e.g. that their programme is “based on the theory that the remedying of the child’s perceptual disorder enables him to relate the surface structure of speech to the deep structure” (p. 26). Concerning methodology, the authors provide little detail about the r61e of language in their work. They claim that their approach is non-verbal, that is “we do not treat through the defective medium” (p. 51). But the one child they give us a detailed account of had had considerable language contact and therapy before their programme started, and it is left quite unclear, in the discussion of the visual and auditory sequencing tasks which constitute part of the programme, how much and what kind of language was used to the boy or around him in the instructions and discussion of the tasks (pp. 22-23). It seems unlikely 400
LETTERS TO THE EDITOR
that the programme was carried through in complete silence, and no account seems to be taken of the language contact he was receiving out3ide the clinic, where he was being seen for one hour each day. In this respect, attributing the improvement obtained to the perceptual hypothesis seems premature. They put the questions: ‘Is it reasonable that the medium of remedial education should be the one in which his disability lies? Can a disorder of language be remedied by repetitive practice in the medium of language?‘ (p. 36), to which they clearly anticipate the answer ‘Nu’. But a better answer is ‘It depends’, as the questions contain an assumption which linguists would argue is incorrect, namely that language is a single, homogeneous structure. If one takes the view that there are levels of syntactic structure, however, then it is perfectly feasible to concentrate on certain aspects of syntax while ignoring others, right from the beginning of syntactic development. This book does not dissuade me from my belief that linguistic reasoning and technique provide an indispensable element of any remedial procedure in this area. D. CRYSTAL Faculty of Letters and Social Sciences, University of Reading, Whiteknights, Reading RG6 2AA.
Multiple Cranial Nerve Palsies and the Arnold-Chiari Malformation SIR-Dr. Venes’ review of the literature on the multiple cranial nerve palsies associated with Arnold-Chiari malformation ( D M C N , 16, 817) revealed only a single reported case. I would like to add four cases which we reported’, in addition to the five we found in the literature at the time of our review. ROBERTL. SIEBEN 2425 East Street, Concord, California 94520. Sieben. R. L., Hamidam, N. B., Shulman, K . (1971) ‘Multiple cranial nerve deficits associated with the Arnold-Chiari malformation.’ Neurology, 21, 673.
‘Unilateral Nerve Deafness in Childhood’ SIR-Snead et al. ( D M C N , 17, 84) reported a case of unilateral sensorineural deafness due to possible vascular pathology in a child. The description of the audiological data was confusing. They stated that the child had normal hearing on the right and a sensorineural hearing loss on the left. This is consistent with the audiogram presented in Figure I. However, they further state that the Bekesy audiometry showed a 92 per cent tone discrimination on the right and a 46 per cent tone discrimination with no tone decay on the left (Type I). The Bekesy audiometer is an audiomatic audiometer, which allows the patient to plot his own threshold. The end result is an audiogram, not any measure of tone discrimination. The only task of discrimination involved is that of detecting the presence of sound versus no sound. I suspect that the percentages the authors report as tone discrimination represent speech discrimination scores, since they also occur in Figure I and no reference to them is made in the text. The fact that this child had a normal speech reception threshold and poor speech discrimination (46 per cent) on the affected side is a very significant finding that should be pointed out. Poor speech discrimination, with high-frequency hearing loss starting at 2000Hz, is consistent with vascular induced hearing loss. Again, referring 40 I
