I spent the entire day recently listening to a great presentation from Cheryl Scott and Nicole Koonce, both certified speech language pathologists and Ph.D.s. Their topic was “Complex Language: Assessment and Treatment Considerations.” It was a great reminder that other language difficulties might disguise themselves as word finding difficulties. I had previously received a referral from a highly-regarded clinical psychologist, who felt the child in question was experiencing word finding problems. Of course, I administered the Test of Word Finding -3: Standard score = 99. Hmmm.. must be word finding in discourse, right? So I painstakingly transcribed the resulting language sample, and saw very, very few instances of WF. What was going on? Why was the student struggling to express herself when her word finding skills (and a variety of standardized language tests) tested within normal limits? She certainly presented as though she had a word finding problem.
I consulted with the psychologist, and we put our heads together to look at specific examples. What behaviors were we seeing?
We looked at the specific examples of her circumlocutions and substitutions. Her vocabulary and her word finding were fine. However, when she tried to use complex sentences that included imbedded clauses, she struggled both receptively and expressively. My continuing ed experience with Drs. Scott and Koonce jumped out at me. This was a syntax problem, not a word finding problem.
My take away? First, I need to be leery of beginning an evaluation with a pre-conceived notion of what I am looking for. Secondly, it is valuable to confer with colleagues and look at the child as a whole. What academic difficulties is the child experiencing? What language does she use, in both social and academic contexts? In this instance, the teen displayed very appropriate social language, but had difficulty with the expository language demands of her high school classroom. Not a word finding issue, but a significant language disorder that needed intervention.