Part 2: Lessons From Longitudinal Case Studies

We have been reading Topics in Language Disorders for 25 years, just about as long as we have been practicing speech language pathologists. As we ponder on these years of practice, we think about what we have learned from the clients we have served.

The field of speech-language pathology is justifiably concern with treatment outcomes and with selecting treatment methods with scientifically proven value. Most of our intervention studies, however, treat and compare groups of individuals for relatively short periods of time. Language impairment tends to be chronic and pervasive; yet we rarely get the chance to see how intervention interacts with development over the course of several years. Just as important, we rarely get to see how treatment affects the quality of a child's life as he or she matures.

We have collaborated with master clinicians to present five cases of children with various language impairments. The five case studies in this issue describe the children's development over treatment periods ranging from 3 to 15 years. Two of these children presented with language impairment as a primary diagnosis. Brinton, Fujiki, and Robinson describe Stanley, a child they followed from age 5 to 19. Stanley's case demonstrates how devastating language impairment can be as a child grows up. In addition, Stanley's case demonstrates how the pervasive nature of the impairment dictates broad intervention foci, including social and emotional factors. Skarakis-Doyle describes Andy, a preadolescent she followed from age 10 to 13. Skarakis-Doyle altered Andy's previous treatment approach by concentrating on language comprehension to improve reading and language production to enhance social interaction with peers. Andy's case demonstrates that a child's ability to make progress may depend on the incorporation of intervention into important, functional activities.

Two of the case studies describe children with autism spectrum disorders. Craig and Telfer describe Jason, a child they followed from age 5 to 11. Jason presented with hyperlexia, advanced writing skills, and a preference for visual learning materials. Craig and Telfer describe how these strengths were exploited to facilitate Jason's oral language comprehension, participation in conversation, and academic skills. Diehl, Ford, and Federico describe Jose, a child from a bilingual family, from age 3 to 11. Jose's case demonstrates the importance of early, intensive intervention of providing access to the regular educational curriculum, and of teaming with professionals and parents.

Culatta, Setzer, and Horn describe CP, a child with a variety of cognitive, speech, and language deficits. CP was followed from age 4 to 9. This report focuses on a meaning-based phonological intervention program. In CP's case, phonological and language skills improved greatly, but academic and social difficulties became more pronounced.

In each of these cases, we reflect on the growth and challenges these children experienced, on the evolving nature of their disabilities, and on the effectiveness of long-term interventions. We use hindsight to retrace our steps in the clinical process and to ponder on clinical roads not taken. We use foresight to predict what these five children can teach us about future practice. We hope that this extended view of the intervention process will be helpful for researchers and clinicians who strive to understand and treat language impairment.

Martin Fujiki, PhD, CCC-SLP, Issue Editor

Bonnie Brinton, PhD, CCC-SLP, Issue Editor