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From: Ken St. Louis
Date: 10/19/00
Time: 9:39:37 AM
Remote Name: 157.182.12.51
Dear Nan,
This is a very nice paper. Thanks for taking some very difficult material and making it understandable.
Now, maybe I'll muddy the water a bit, but hopefully not too bad. In 1992, I coauthored an ASHA Monograph entitled "Coexistence of Communication Disorder in Schoolchildren." It, as you probably know, is a post-hoc look at a database that we have had at West Virginia University since the early 80s. The database in question came from the so-called "National Speech and Hearing Survey" which was carried out by Colorado State University in 1968-69 and constituted the testing nearly 39,000 *randomly* selected public school children in the contiguous 48 states for speech and hearing. (As hard as it is to believe now, "language" [in the field of speech pathology] had not really been "invented" yet ;-). )
I worked on that survey as an examiner. When the PI, Forrest ("Frosty") Hull retired at CSU, he gave all the data sheets, computer files, and audiotapes to me. Thereafter, we carried out a series of studies using random samples from the database and then analyzing the accompanying audiotapes. We selected groups of fluency, articulation, and voice disordered subjects according to various criteria and then looked for evidence of other disorders. In the absence of language judgments on the datasheets, we developed a few language measures that could be calculated from the conversational samples that had been tape recored for each subject. Overall, we found an incredible degree of coexistence across the various disorders. Moreover, the more severe the selected disorder or measure of overall severity, the greater the degree of coexistence of nearly all the other disorders.
Given what we found, I am not the least surprised that you found that expressive language compromised children are more likely to manifest increased disfluencies and--depending on the criteria for inclusion--stuttering. My guess is that they are also much more likely to manifest articulation/phonological errors, voice deviations, and hearing loss (if measured in very small increments).
The problem is that when we see a person in the clinic, we almost instinctively decide what their primary diagnosis is. Of course, this is appropriate. But what often happens is that we begin to systematically ignore other problems that might also be there unless they become severe enough to compete with the original diagnostic symptoms. And, of course, this complicates treatment dramatically. In spite of dramatic gains in the past two decades, we still know precious little about which treatment is the *best* for a client with a "pure" language or stuttering problem. And we know next to nothing about the most appropriate strategies for clients that manifest both language and stuttering disroders or those problems plus one, two, or three more. But, in spite of our wishful thinking otherwise, these cases with multiple coexisting problems are *much* more common than any of us realized. Look at the references to and questions about ADHD and stuttering in the on-line conference, for example.
I don't have the solution, but science usually uncovers problems more readily than answers. Congratulations to you and your students in helping with the process.
Ken