When in my clinical practice I have to explain to parents of children with spoken language problems the situation of their offspring, I note the high level of difficulty they exhibit in their assimilation, something that is more than justified, given that the treatises on the subject tend to be complicated and riddled with technicalities and confusing, if not conflicting theories.
The aim of these lines is to simplify the subject as much as possible so that it can serve as a “small conceptual survival guide”.
There are two types of language problems: language delays and language disorders.
I find very illustrative and simple the classification of language problems that subdivides them into two large groups: language delays and language disorders. The first group includes children who present a linguistic level corresponding to a developmental age lower than the real one (children of 6 years old who speak with a normal language but for an age of 4 years old, for example). The second group includes cases where the deviations detected are not present at any previous developmental stage. The members of the first group generally have a better therapeutic prognosis.
From the perspective of pathology, many of my patients ask themselves a previous question: How do you establish what and how is a normal language? The truth is that, once again, there are many theories written on the subject and with them comes confusion. In my opinion, one of the most clarifying approaches comes from the modular theory of language, which considers, broadly speaking, language to be made up of three major modules, each with its own autonomous rules but interrelated among themselves. These are: form, content and use. The first encompasses the rules that define the “container” in which each language presents its message, which in turn is subdivided into two: phonology (or rules for combining sounds) and morphosyntax (or rules for making words and phrases). Thus, if a child says: “Mi cafa es gonita” (for “Mi casa es bonita”), he/she presents phonetic errors but not morphosyntactic errors. However, if he says “Mis casa es bonitas” he does not make any phonetic errors but does make morphosyntactic errors.
The content is the “dictionary” that each child has to have integrated into his or her background, depending on his or her age. And usage is the adaptation to each communicative environment in order to achieve effective communication (for example, the linguistic register used at a dinner with friends is not the same as that used at a work dinner with the boss). The undersigned feels that little effort is devoted to rehabilitating the use of language, compared to the effort devoted to form and content, when the use of language is of decisive importance for effective and efficient communication. Let us think, for example, of an adolescent with Down syndrome who, in spite of making some errors in phonetics or morphosyntax, is capable of adapting his or her use to the present communicative environment. This child may be more efficient and empathetic than another adolescent with a better verbal technique but with inadequate or “politically incorrect or unpleasant” staging from a linguistic point of view.
For diagnosis, standardized tests and observation of spontaneous language are used.
For the diagnostic assessment of all these aspects, standardized tests are used, but it is very important to observe spontaneous language in open environments (the child expresses without guidelines) or closed environments (the explorer poses guidelines), and it is also very important to explore the child’s hearing and listening, since if these present problems, the development of language is compromised. The key lies in a comprehensive approach to all the processes described.