Journal of Speech and Hearing Disorders,Volume 55, 612-620, November 1990

WHO SHALL BE CALLED LANGUAGE DISORDERED? SOME

REFLECTIONS AND ONE PERSPECTIVE
MARGARET LAHEY
Emerson College, Boston

This paper discusses some issues involved in identifying children who have language problems. The perspective taken is that
(a) the goal of identification must be clearly distinguished from other goals of assessment; (b) identification of children with
language disorders is better based on language performance than on inferences about the language knowledge that underlies this
performance; (c) language performance must be sampled in more than one context, including, for purposes of identification,
contexts that stress the language system; (d) the standards of expectations for comparing performance and determining differences
must be explicit; (e) standards used to determine differences are better based on the performance of chronological-age peers than
on the performance of children with similar mental abilities; and (f) children who do not evidence poor language performance but
are considered at risk for language-related problems should be distinguished from children who demonstrate poor language skills.

KEY WORDS: language assessment, language disorders in children, age-equivalence scores, identifying language disorders,
cognition and language

The criteria and procedures for identifying children
with language disorders appear to vary widely among
research and clinicians. This diversity creates confusion
about the meaning of the term language disorder-con-
fusion among clients, students, service-providing agen-
cies, and schools, as well as speech-language patholo-
gists. The use of varying criteria could interfere with our
ultimate understanding of language disorders. Further-
more, in these days of increasing health and education
costs and decreasing availability of funds, unclear criteria
are more and more likely to be questioned by those called
upon to pay for services to language-disordered children
(see Frattali, 1990, for a discussion of a similar problem
with defining quality of service).
Although we do not now all agree on a particular set of
criteria for defining a language disorder, most of us would
agree that we need to be explicit about and critically
evaluate the criteria that are used. Such examination may
allow us to eliminate those criteria that cannot be justified
or do not prove useful, and perhaps gradually reduce
some of the confusion that exists about who shall be
called language disordered.
This article evolved from a critical examination of a
frequently used criterion for identifying children with
language problems-a criterion based on a discrepancy
between language age and mental age. Isolation of that
one criterion proved impossible without discussion of
more general issues related to assessment, language, and
what makes a difference. The perspective taken here is
that (a) the goal of identification must be clearly distin-
guished from other goals of assessment; (b) identification
of children with a language disorder is better based on
language performance than on inferences about the lan-
guage knowledge that underlies this performance; (c)
language performance must be sampled in more than one
context, including, for the purpose of identification, con-
texts that stress the language system; (d) the standards of
expectations for comparing performance must be explicit;
(e) standards used to determine differences are better
based on the performance of chronological-age peers than
on the performance of children with similar mental abil-
ities; and (f) children who do not evidence poor language
performance but are considered at risk for language-
related problems should be distinguished from children
who demonstrate poor language skills. These points are
further discussed below.
GOALS OF ASSESSMENT
As speech-language pathologists, we are often asked to
assess children who someone (parent, teacher, doctor,
etc.) has hypothesized may be having difficulty learning
language or using language to communicate. One goal of
such assessment is to confirm or reject this hypothesis.
This goal can be viewed as identification.
Identification is followed by careful description of the
child's communicative behaviors, as we attempt to deter-
mine, for example, what changes could be made, what
impact these changes might have, and what the reason for
the problem is. Identification of a language disorder is not
a statement about etiology or the nature of a problem.
Furthermore, it does not imply that we can help a child
nor that we must continue working with a child until the
child no longer manifests language problems. Procedures
for identification of a language disorder are different from
those used to determine goals of language intervention;
they are different from those used for understanding the
nature of language disorders. Even with these limits,
however, identification is not easy and is fraught with
controversy. Most of the controversy involves issues
about how we view language and how we determine
what a "disorder" is.'
'Throughout this article I refer to children with language
problems as "language disordered," in line with common usage
(e.g., Aram & Nation, 1982; Bloom & Lahey, 1978; Carrow-

© 1990, American Speech-Language-Hearing Association 612 0022-4677/905504-061201.00/0

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SOME ISSUES RELATED TO
LANGUAGE
No agreed-upon theory of language or language devel-
opment is available to help us in the identification of
language disorders. We cannot wait for such a theory to
resolve some of the problems associated with identifica-
tion. In fact, an understanding of children who are having
difficulty learning and using language may well inform
theories of language and of language acquisition. An
understanding of these children is, however, dependent
on identifying them.
Early studies of language yielded taxonomic descrip-
tions of the linguistic forms used for expression. Devel-
opmental studies tended to focus on listing the forms that
were found at different ages (e.g., Templin, 1957). These
studies either were atheoretical descriptive studies or
were based on a maturational view of development (i.e.,
that the sequence of development is predetermined by
genetic code) (Bloom & Lahey, 1978; Kuhn, 1988). The
data collected in these studies are still used to refer to
developmental milestones in language development.
Another view of development, behaviorism, was inter-
ested only in the observable behaviors and, thus, also
focused on the form of language. In this view, develop-
ment is a product of environmental influences. Complex
behaviors are considered a constellation of smaller be-
haviors that must be isolated and studied in order to
understand the complex behaviors. Research about de-
velopment often involved laboratory studies of learning,
in particular paired-associate learning. Learning was
viewed as a cumulative process, and the counting of
forms as a measure of development is consistent with this
perspective.
In the developmental psycholinguistic literature that
has predominated since the 1960s, there has been a
marked trend away from a focus on taxonomies of form,
counting forms, and providing ages associated with the
production of these forms. Language is viewed as knowl-
edge that underlies the observed behaviors. In contrast to
a behavioral perspective, it is a mentalistic perspective.
This perspective has most often considered development
in terms of the interaction between the child's genetically
determined endowment and the environment. Differing
views exist concerning the relative role of the child
versus that of the environment.
What children know about a linguistic system or about
communicating with language is not directly observable.
They manifest that knowledge through acts of expression
and interpretation. [This distinction between language
knowledge and the manifestation of that knowledge has
Woolfolk, 1988; Cole, 1982; Committee on Language Learning
Disorders, 1989; Holland, 1984; Hubbell, 1981; Lahey, 1988)
and because we in the field of speech-language pathology
usually refer to the various areas of our field as disorders (e.g.,
voice disorders, phonological disorders, speech disorders). Al-
though some other term (e.g., disability, delay, impairment) may
be more appropriate, such discussion is not the purpose of this
article.
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LAHEY: Language Disorders 613
been made by many; examples are Sapir's (1921) distinc-
tion between "langue and parole" and Chomsky's (1972)
distinction between "competence and performance."]
What is observed is the form of communicative behaviors.
However, researchers within the mentalistic perspective
are concerned with describing development by inferring
changes in the knowledge underlying the observed be-
haviors (e.g., Bloom, 1970; Bowerman, 1973; Brown,
1973).
Forming taxonomies and counting behaviors continues
even for those who operate with a mentalistic view of
language. However, the taxonomies formed, the purpose
of forming and counting, and the interpretations of the
data have changed. At first, the inferred structures were
related primarily to the form of language (in particular,
rules of syntax), but in the past two decades they have
also included interpretations of linguistic form and other
behaviors (e.g., gaze, facial expressions, actions on ob-
jects) so that aspects of language content and use are
inferred and categorized. Rather than ages at which
certain categories of behavior are expected, the new
taxonomies and their quantification are used for other
purposes, including the following: inferring the structure
underlying the form; inferring the emerging knowledge
of a rule versus the "mastery" of a rule; inferring pro-
cesses related to language learning; examining the influ-
ence of context on the production of particular forms; and
comparing description of expression and interpretation
through language with behaviors of different kinds (e.g.,
Bates, 1976; Bloom, 1970; Bloom & Beckwith, 1989;
Brown, 1973). Although the emphasis on the role of the
environment in learning is controversial, there is consen-
sus that environment and the context of observations
influence what behaviors are observed and when partic-
ular behaviors appear to emerge.
Like the researcher in normal child development, the
clinician also describes and interprets behavior with the
intent of understanding the underlying system and pro-
cesses that are not directly observable. Like the re-
searcher, the clinician has only the data of performance.
But, unlike developmental psycholinguistic researchers,
clinicians are also asked to identify children who are
having problems learning and using language. One con-
cern is whether such identification should be based on
the manifestation of language knowledge (i.e., compari-
sons of language performance with some expectation of
performance) or on the inferred underlying knowledge
system (as compared with some expectation for that
system).
The perspective taken here is that, even within a
mentalistic view of language, identification of a language
disorder should be based on differences in language
behaviors (e.g., the production and comprehension of
units of connected language) and not on inferences about
the nature of the underlying system based on these
performance variables. One reason to focus on perform-
ance is the practical consideration that there is no agreed-
upon way to describe the underlying system and, thus, no
way that a description of the expected system could be
used as a comparison. More important is the fact that we
 614 Journal of Speech and Hearing Disorders
are interested not only in children who have deficits in
their underlying knowledge of language but also in those
who might have difficulty in accessing or using that
knowledge.
What children can do with the knowledge they have
may be as important for prognosis and intervention as
what they know about the linguistic system. Transitions
associated with changes in curriculum as well as literacy
demands may result in previously undisclosed difficulties
with language tasks for certain children (Bashir, Wiig, &
Abrams, 1988). A few studies have indicated that some
children who score within normal limits on standardized
language tests and who carry on acceptable casual con-
versations have difficulty learning to read (Liebergott,
Menyuk, & Chesnick, 1988). Many of these children are
also different from peers on certain language processing
tasks. For example, some have difficulty on language
tasks that emphasize speed and accuracy of language
processing (e.g., speed of naming objects, accuracy of
rapid multisyllabic word repetition) or metalinguistic
skills (e.g., phoneme segmentation, doze tasks) (see, e.g.,
Kamhi & Catts, 1986; Liebergott et al., 1988). Further-
more, evidence of excessive numbers of dysfluencies
(e.g., pauses, false starts, interjections) in connected
speech have been found predictive of, or negatively
correlated with, academic success (e.g., Damico, Oller, &
Storey, 1983; MacLachlin & Chapman, 1988). Problems
with comprehension versus production skills may also
cause children to differ in performance relative to peers-
some do as well as peers on one type of performance but
more poorly than peers on the other (e.g., Stark & Tallal,
1981). Although some of these discrepancies may be
related to differences in the knowledge base underlying
language, others appear to be related to processing (i.e.,
in accessing or using) that knowledge. It is not always
easy, or possible, to differentiate the two.
These variations in the manifestation of language
knowledge suggest that identification of language disor-
ders should include descriptions of how children use
language and should not be based solely on inferences
about the nature of the knowledge. Performance needs to
be observed in a number of contexts and cannot be
limited to current standardized instruments that describe
the production and comprehension of certain lexical and
syntactic forms in limited noncommunicative contexts or
to a sample of language in casual conversation. Proce-
dures of identification also need to include conditions
that might stress the language system (such as speeded
performance or narration of complex ideas). For such
procedures to be useful in identifying language-disor-
dered children, we need information on how large num-
bers of children perform on similar tasks so that we are
aware of the variability in performance among children
and so that we have a standard of comparison.
In the perspective presented here, description of best
performance and of differences between best perform-
ance and performance under stressed conditions are not
necessary for identifying children who are having diffi-
culty with language. Such descriptions are more relevant
for other goals of assessment, such as understanding the
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55 612-620 November 990
nature of the problem and planning intervention. Thus,
despite the fact that most of us operate within a mental-
istic perspective and are interested in making inferences
about the underlying language system, it seems we
should define language disorders in terms of differences
from some expectation about language performance.
SOME ISSUES RELATED TO BASIS
OF COMPARISON
Perhaps the most controversial issues in identification
have to do with the standards upon which we base our
comparisons and thus judge who shall be called language
disordered. The past two decades have provided us with
the information necessary for improving our descriptions
of children's performance and with developmental se-
quences that are helpful as a standard of comparison for
determining the goals of intervention. However, we have
not come to terms with a standard of comparison for the
purpose of identification.
We always compare a child's performance with some
standard of reference (implicit or explicit) when identify-
ing difference or "disorder." Perhaps the greatest danger
comes from the use of intuitive or vague alternatives that
are not open to examination and lead to confusion as to
what we mean by the term language disorder.
Although the standards of expectations we use for
identifying a language disorder are not always explicit,
they are usually based on the communicative behaviors of
other children in the child's culture who either are at the
same level of cognitive development or are of similar
chronological age. Even the standard of effective commu-
nication or conspicuousness (e.g., Van Riper, 1954) is
usually determined from the perspective of a child's age
or level of mental ability.
One frequently used method of comparison is to com-
pare mental age (MA) and language age (LA) and consider
differences of 6 months to 2 years as evidence of a
disorder (e.g., Stark & Tallal, 1981). The estimate of
mental ability encompassed in MA is usually derived
from the accuracy of responses on a test or subtest of
intelligence, and the estimate of language level is usually
derived from the accuracy of responses to tests of lan-
guage or by comparison of language performance to
developmental milestones (e.g., use of a language scale).
Multiple problems exist in using MA-LA discrepancy as
a criterion. Some of the problems relate to measurement
concerns, such as the problems inherent in age-equiva-
lence scores and in comparing any two measurements.
Other problems have to do with the use of mental
abilitiesas a comparison, including deciding which men-
tal abilities to use and the theoretical relation between
language and mental abilities.
Measurement Concerns
Equivalencescores. The equivalence score is the frame
of reference used when one describes children's perfor-

mance in terms of language age, mental age, or grade
level. Such scores generally refer to a measure of central
tendency (usually the median or mean) of a segment of
the standardization sample. For example, to say that a
child has a language age of 4 years means that the score
the child received on a measure of language is the
median, or mean score, received by the 4-year-old chil-
dren in some standardization population. This method of
describing "normal" development and deviance from
normal is extremely problematic.
Equivalence scores usually do not compare children
with a population to which they belong. For example, if a
5-year-old child receives a language age score of 4 years,
this tells us about the child's performance in relation to an
estimate of the "average" 4-year-old, but does not tell us
about the child's performance in relation to other 5-year-
olds. A second problem with equivalence scores is that
they do not represent linear units. That is, each month of
difference in age is not equivalent in terms of number of
errors, either within a test or between tests, and a lan-
guage age unit (of months or years) cannot remain con-
stant with varying chronological ages. A 1-year difference
in age score when a child is 3 years old is not equivalent
to a 1-year difference when the child is 9 (see Anastasi,
1982, for further discussion). Interpretation of "how much
of a difference makes a difference" is, therefore, difficult.
A third problem is that equivalence scores are easily
misinterpreted. For example, a third grader who receives
a reading grade-level score of sixth grade has done very
well on the third-grade test, probably as well as a sixth
grader might have done had he or she taken the third-
grade test. (Note, however, that often such scores are
obtained by extrapolation rather than by actual adminis-
tration of the test to a sixth-grade group.) It is unlikely that
the third-grade child reads as well as a sixth grader or
could score anywhere near the 50th percentile on a
sixth-grade reading test (see Cronbach, 1984, for further
discussion). The skills tested at each grade level are quite
disparate, and the use of grade equivalence scores masks
these differences.
These and other problems with equivalence scores
have been discussed by many professionals in our own
literature (e.g., Bloom & Lahey, 1978; Lahey, 1988; Lund
& Duchan, 1988; McCauley & Swisher, 1984) and in most
texts on measurement (e.g., Anastasi, 1982; Cronbach,
1984; Salvia & Ysseldyke, 1981), yet they continue to be
used. A cursory review of articles that appeared in the
Journal of Speech and HearingDisordersand theJournal
of Speech and Hearing Research between December
1984 and December 1988 revealed that approximately
40% of the articles that concerned language learning
problems in children (as evidenced by their titles) de-
scribed the language-disordered child using only equiv-
alence scores. Another 20% used equivalence scores
along with standard scores. Furthermore, the American
Speech-Language-Hearing Association (ASHA) sells a
poster suggesting that the parent "Find your child's
speech and hearing age," (advertised in Asha, June 1987,
p. 70). Because of the problems mentioned above, it may
be that we should call a moratorium on the use of all
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LAHEY: Language Disorders 615
equivalence measures in our journals and other official
publications, and their use should be discouraged in our
clinic and school reports.
If we cannot refer to level of development in terms of
age or grade equivalence, what are the alternatives?
Description of a child's performance relative to the vari-
ability found in a comparative population is more accept-
able than age equivalence. Percentile ranks,2 standard
scores, or number of standard deviations from the mean
are indices commonly used in descriptions of language
behavior. Such scores are available for most of our re-
cently published language tests. Furthermore, some de-
scriptions of language samples can be reported in terms of
number of standard deviations from the mean for children
of different ages (e.g., mean length of utterance as pre-
sented by Miller & Chapman, 1981; aspects of syntactic
complexity as computed by Lee, 1974; number of dif-
ferent words using data by Templin, 1957). In the future,
the use of computerized databases may enable us to
provide more varied descriptions in such a manner. In
any case, reporting performance in a way that enables us
to interpret a child's relative standing with peers is
preferable to describing the performance relative to the
central tendency of some age group (i.e., an age equiva-
lent).
Comparingtwo observations. Even if we refer to stan-
dard deviations or standard scores as an estimate of
mental ability and of language, further measurement
problems arise when we attempt to determine differences
between the two observations. All observations (be they
informal or formal) are subject to multiple sources of
error. A significant portion of the error that relates to
contexts and variability of the child could be eliminated if
it were possible to observe the child all the time rather
than sample the child's behavior. Because observing the
entire universe of the child's behaviors is impractical, we
need to be concerned with reducing sampling error and
estimating its influence. Some of this observational error
is estimated by measures of reliability. In general, the
larger the sample of behaviors observed, the higher the
reliability. The standard error of measurement (SEM) is a
way of taking this source of error into account when
interpreting an observation. It can be computed if reli-
ability and standard deviations are available for the ob-
servational technique of interest. Many standardized tests
report SEM, and it should be used to estimate the band
around which an individual child's true score probably
falls.
In comparing the results of observations of language
with those of mental abilities, apparent differences or lack
of differences could be a function of error in the observa-
tion or description of each. Observation techniques with
lower reliability need greater differences, whereas those
with higher reliability require less. To determine the
2
Percentile ranks provide a comparison with peers in terms of
relative standing and in that sense are better than equivalence
scores, but they are less useful than standard scores because the
differences between ranks do not represent equivalent units.
 616 Journal of Speech and Hearing Disorders
likelihood that disparate findings reported for different
observations are not due to errors in observation or
description, we can calculate the SEM of the difference
between the two measures (see, e.g., McCauley &
Swisher, 1984; Powell & Peng, 1989; Reynolds, 1981;
Salvia & Ysseldyke, 1981). The SEM of difference should
be reported and considered in research studies or clinical
reports that identify a language disorder based on com-
parisons of level of language with level of mental ability;
it is not usually referred to in journal articles or clinical
reports that use mental abilities as the comparison. Esti-
mates of the standard error of the difference are not
available in test manuals and need to be computed by the
clinician or researcher for comparisons of different mea-
sures. Although it is essential to determine whether
differences between two measures are significant, the
presence of significant differences does not indicate the
frequency of such differences in the population (although
this can be estimated given the intercorrelation of the
measures) or whether the differences are of any theoret-
ical significance (Reynolds, 1981). Thus, the use of any
standard of reference for defining a language disorder that
relies on differences between the two sources of obser-
vation (such as language and mental ability) involves
potential compounding of measurement error. In addition
to these measurement problems, there are theoretical
reasons why comparing language level with level of
mental ability is problematic.
Concerns About the Use of Mental Abilities as a
Comparison
Which mental abilitiesdo we consider? Although some
models and theories of intelligence define intelligence in
terms of a unified capacity, others suggest that intelli-
gence is composed of distinct mental abilities (e.g.,
Gardner, 1985; Wing, 1981; see Weinberg, 1989, for a
review). In fact, Gardner (1985) has suggested that there
are several "types of intelligence," each of which has a
certain degree of autonomy, as evidenced by prodigies
and by the differential effects of brain damage. This view
of multiple intelligences leads to the perplexing problem
of deciding which particular types of intelligence should
form the basis of comparison with language skills. Using
Gardner's types, we might ask whether linguistic intelli-
gence should be compared with logical-mathematical,
personal, bodily-kinesthetic, musical, or spatial intelli-
gence. Few tests measure personal, bodily-kinesthetic, or
musical intelligence. According to Gardner (1985), most
of our traditional intelligence tests measure linguistic
and/or logical mathematical domains. For the purpose of
identifying a language disorder, is there any reason to
assume that a gap between linguistic and logical-mathe-
matical intelligence is any more important than a gap
between linguistic and any other type of intelligence? If
autonomy exists among domains of intelligence, is there
any value in identifying a problem by comparing one
domain with another?
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55 612-620 November 1990
Other researchers and theorists have focused on infor-
mation processing components of task performance (e.g.,
Case, 1985; Sternberg, 1985), or mental structures (e.g.,
Piaget, 1954) that cut across domains of knowledge and
are purported to be involved in all intellectual activity. In
essence these approaches focus on how children solve
problems. They suggest that the strategies used by the
child are more important than whether or not the solution
was correct. Development is often viewed as a reorgani-
zation of strategies or structures that enables more effi-
cient problem solving. More recently, emphasis has fo-
cused on the metacognitive understanding of when to
apply which strategies (e.g., Kuhn, 1988; Muma, 1986).
Information about the individual's real-world adaptation
(i.e., the individual's sociocultural context) or about how
a person handles novel versus automated experiences is
considered more important than the accuracy of the
person's responses to particular test items (Sternberg,
1985). However, scores on traditional intelligence tests
are based on the accuracy of a child's response. That is,
they are a measure of the product of cognitive activity, not
with how a child arrived at the product (Sternberg, 1985).
Theoretical relation between language and mental
ability. A further problem with the use of scores on
intelligence tests as a reference point for identifying
children with language learning problems relates to the
theoretical relation between language and mental abili-
ties (for review, see, e.g., Rice & Kemper, 1984; Siegel,
Katsuki, & Potechin, 1985). Tasks on intelligence tests are
not theoretically motivated in terms of language develop-
ment. Measures of responses to intelligence tests (e.g.,
MA or IQ) are often referred to as an index of cognitive
development, but they do not represent the view of
cognitive development that has most often been studied
relative to language development. Most studies that have
related language learning to cognitive development have
focused on how the child represents the world and the
ways in which the child can manipulate those represen-
tations. They have defined cognition more in terms of
Neisser's (1967) definition, that is, as the processes by
which sensory input is transformed, reduced, elaborated,
stored, recovered, and used. Thus, developmental psy-
cholinguists have not been concerned with MA, IQ, or
any measure of the accuracy of responses; rather, they
have been concerned with how the child arrives at those
responses.
Most of this work in developmental psycholinguistics
has been influenced by the writings of Jean Piaget, who
was interested in how a child formulates and solves
problems. Many studies have looked at correlations be-
tween aspects of sensorimotor development, as described
by Piaget, and early lexical acquisition. For example, a
number have reported that the child's earliest words
appear in sensorimotor Stage 5 (e.g., Bates, 1976). How-
ever, comparisons of language skills and Piaget's descrip-
tions of early cognitive development have revealed
mixed results. Some studies report positive correlations
between object permanence and types of words learned
(e.g., McCune-Nicolich, 1981); others have found none
(e.g., Corrigan, 1978). These correlations appear to vary

with the level of language development and the aspect of
sensorimotor development measured (e.g., Bates, 1976;
Thal & Bates, 1988).
The reported correlations have been criticized on a
number of grounds (see, e.g., Bloom, Lifter, & Broughton,
1985; Lifter & Bloom, 1988). For example, it is not clear
that scales of sensorimotor development (e.g., Uzgiris &
Hunt, 1975) are the best estimate of the development
described by Piaget. Most scales, again, tend to focus on
the product rather than on the means by which the child
solves the problem (see Bloom et al., 1985, for a review).
Finally, and most important, traditional intelligence tests
do not measure this type of cognitive development. No
theoretical basis exists for assuming that the score on an
intelligence test (except extremely low scores) should
predict current level of language learning, or that it
should be the point of comparison for determining
whether a child has a language disorder. 3
Until we have a better understanding of the relation
between measures of language and measures of mental
abilities, we must be cautious when using any description
of mental ability as the reference point in the identifica-
tion of language disorders. The confusion may be related
to methodological problems in measuring both language
and cognition (see Bloom et al., 1985, for further discus-
sion of methodological issues). On the other hand, the
hypothesis that cognitive development sets the limit on
language learning may be too vague to be correct or may
be incorrect. Certainly language itself ultimately influ-
ences cognition, although when that happens is not clear.
The point here is not to argue against the possibility that
cognitive development leads and limits language devel-
opment at some time in development. That issue is yet to
be resolved. Rather, the argument is that evidence based
on current tests of intelligence does not relate to such an
hypothesis. Given these theoretical concerns about the
relation of measures of language to measures of mental
abilities, and given the concerns about compounded error
when any two measures are compared, the perspective
taken here is that language disorders should not currently
be defined by comparing a level of language ability with
a measure of mental ability.
Other Standards of Comparison
Chronological age as a standard of reference. When
chronological age (CA) is used as a standard of reference,
a child's language performance is compared with that of
children born at a similar time rather than that of children
with similar scores on measures of mental ability. One
advantage of using CA is that it is rarely subject to
3
Certainly, the use of intelligence tests has been critiqued by
many (see, e.g., Baumeister & Muma, 1975). The position here is
not that intelligence tests (or any measures of the product of
intellectual activity) are not useful for some purpose, only that
they are not useful as a comparison for expected language
performance.
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LAHEY: Language Disorders 617
measurement problems. As a consequence, the problem
of estimating the compounded effect of measurement
error from two observations is eliminated. The use of CA
does not, of course, eliminate the need for considering
observational error in the description of language. An-
other advantage is that the use of CA as a standard does
not imply any unidirectional relation between cognition
and language. Furthermore, the use of CA suggests that
all children with poor language skills should be consid-
ered for intervention services even when their language
skills are similar to those expected, given a measure of
mental ability. This perspective was supported in a re-
cently reported intervention study in which children with
MA equal to LA made as much progress in language
learning as children whose MA was higher than their LA
(Cole, Dale, & Mills, in press). Although many agree that
children whose poor language skills are equivalent to
their mental abilities should be considered for language
intervention (e.g., Leonard, 1983; Subcommittee on Lan-
guage and Cognition, 1987) others do not provide direct
programs for such children (see, e.g., Lyngaas, Nyberg,
Hoekenga, & Gruenewald, 1983).
One danger in the use of CA is that it too often gets
compared to a language age as, for example, in scales or
references to developmental milestones. The problems
with the use of age-equivalence descriptions were dis-
cussed above. Considerable variability exists among chil-
dren in the age at which different language behaviors are
manifested. Comparisons of a child's language perfor-
mance with that of CA peers need to consider the vari-
ability of performance among these peers. To know how
a child's language performance compares with that of age
peers requires the use of measures that describe a child's
relative standing (e.g., the number of standard deviations
from the mean or standard scores). On behaviors for
which there is a wide variability among children, the
deviation scores will reflect greater differences from the
mean score.
But taking account of this variability does not tell us
how far below average (i.e., how many standard devia-
tions below the mean) a score must fall to be considered
as evidence of a language disorder. A number of research-
ers and clinicians have settled on somewhere between
one and two standard deviations below the mean (e.g., a
standard deviation of 1.5) or below the 10th percentile
as a temporary solution (e.g., Lee, 1974; Swisher &
Demetras, 1987). To my knowledge, no one has placed
such a criterion in the framework of the standard error of
measurement. If the normative population is made up of
only "normal" children (as is the case for most of our
language tests), it would seem that the criterion of 1.5
standard deviations below the mean should be the high
point within the band of confidence interval-that is,
given the standard error of measurement, the chances are
likely that performance did not fall above -1.5 standard
deviations.
Until we have evidence of language performance on
randomly selected children of particular ages (i.e., not
just on those who have been determined to be nondisor-
dered), it could even be argued that any performance, no
 618 Journal of Speech and Hearing Disorders
matter how poor, that is also observed in non-language-
disordered CA peers cannot be used as evidence of a
language disorder. For example, on a test, the lowest
score obtained by a non-language-disordered child would
be used as a criterion; only those scores that fell below
the lowest score attained by a nonimpaired child would
be used to support the hypothesis of a language disorder.
Eventually, it is possible that our standard of compari-
son and the degree of difference from this standard will
be empirically determined by longitudinal data that pro-
vide information about clusters of variables that make a
difference. That is, what deviations on what language
behaviors coupled with what other information suggest
that a child will have trouble in school and in life? (See
also Tomblin, 1983, as cited in Fey, 1986.) Such a solution
will not be reached, however, if we continue to ignore the
variability among children by using equivalence scores or
if we confound the problem by comparing two sources of
measurement and assume some theoretical tie between
intelligence scores and language performance. In the
meantime, the use of measures that reflect the wide range
of language performance among children (in contrast to
age equivalences that reflect only central tendencies)
serves constantly to remind us of the variability within
the population of "normal" language learners and makes
us cautious in the use of any one observation to label a
child as "disordered."
Although I am suggesting that observations be reported
in a way that takes into account the variability in normal
children, I am not stating that standardized tests are
essential nor that they are the only way to observe
language performance. Descriptions of nonstandardized
procedures, such as language samples, can also poten-
tially take into account the variability among children if
data can be obtained on large numbers of children in
similar contexts. The problems with standardized tests
have been well documented (see, e.g., McCauley &
Swisher, 1984; Muma, 1985). These problems are not,
however, automatically solved by the use of nonstandard-
ized procedures. All types of observation are open to the
same criticisms as those applied to tests.
Other alternatives. One problem that is often raised
about the use of CA as a reference is that some children
with average or low-average performance relative to a
national sample of CA peers might be at great risk for
social and academic failure in a home or community
where 80-90% of the children perform well above aver-
age. Should this child be denied help from a speech-
language pathologist if the child's language performance
can be facilitated by this help? Most speech-language
pathologists would probably agree that the child should
not. The more controversial question is whether such a
child should be labelled "language disordered."
One solution is to devise two categories. One category
would be for those who evidence poor language skills, at
least when the system is stressed. (They could be called
"language disordered.") The other category would be for
those who may demonstrate average or low-average skills
but for whom environmental, or other, factors place the
child at risk for future problems related to language
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55 612-620 November 990
learning or use. (We could call them "at-risk for language-
related problems.") In many ways such a distinction
would be preferable to the current confusion, which
mixes the two. It also is in line with the categories being
developed for services to infants and toddlers. However,
an "at-risk" category could be a wastebasket and a name-
playing game if vague clinical hunches are used without
explicit specification of the exact conditions that place
that child at risk, including a rationale for why the child is
at risk. Only when such conditions are made explicit can
we begin to test these hypotheses.
Still another potential solution to the problem is to
serve all children and not just those identified as lan-
guage disordered. A number of our colleagues are rede-
fining their role as speech-language pathologists within
the school environment (see, e.g., Miller, 1989). They are
acting as consultants who work to facilitate the commu-
nication skills of all children and not just those who have
been diagnosed as disordered. This move was not moti-
vated by the problem of defining language disorders, but
it might serve to eliminate the problem where applied.
The model seems more appropriate to the school than the
clinic, but in any case it will eliminate the problem only
if funding for the services of speech-language patholo-
gists is not tied to the number of children who are called
"language disordered."
SUMMARY
Some issues concerned with the identification of chil-
dren who have difficulty learning or using language have
been presented. The perspective presented distinguishes
procedures of identification from procedures related to
other goals of assessment, such as understanding the
nature of the problem and planning intervention.
The first point made was that identification of children
with a language disorder is best based on language
performance and not on inferences about the knowledge
that underlies this performance. The reasons given in-
cluded the fact that children whose major problem is with
accessing or using language knowledge may be in as
much need of intervention as those who have deficits in
the knowledge itself. It was suggested that procedures for
identifying children with language disorders include
tasks that stress the use of the language system so that
difficulties in performance would most likely be evident.
Probes to determine a child's best language performance
and to make inferences about the language system under-
lying that performance are considered more relevant to
planning language intervention and to understanding the
nature of the problem than they are to identifying chil-
dren who have problems learning and using language.
In assessment we often compare descriptions of our
observations with some standard of expectation. The
standard for comparison varies with the goal of assess-
ment. For example, when planning goals of intervention,
the sequence of development of particular behaviors may
be the standard to which we compare our observations
(e.g., Bloom & Lahey, 1978; Lahey, 1988; Lee, 1974;

Miller, 1981). When identifying children who have lan-
guage learning problems, we also describe a child's
language performance in relation to some implicit or
explicit expectation. A major controversy, however, lies
in agreeing upon the standard to use as the basis of
expectations. In this paper I have argued against a stan-
dard that is based on a measure of mental ability (e.g., the
LA-MA discrepancy) and suggested that comparisons of
language performance of children with similar CA is a
better option (although not without problems).
The reasons for preferring CA to MA as a reference
included measurement concerns such as problems with
the use of equivalence scores and difficulties involved in
determining differences between two scores (each of
which has measurement error). The reasons also included
concerns about the use of mental abilities regardless of
measurement concerns. For example, it is difficult to
decide what aspect of mental abilities we want as a
comparison. Furthermore, claims about the theoretical
relationship between language and cognition have not
been based on intelligence test scores but on measures of
the way children represent and manipulate representa-
tions of information; and even here, the relationship is
controversial.
A few alternatives to, or variations on, the use of CA as
a comparison standard were briefly discussed. As long as
definitional criteria are unclear, it will be difficult for us to
further our understanding of the children we serve under
this label. None of us has "the perfect solution" to who
shall be called language disordered. It is unlikely that we
will ever approach such a solution or even reach a
tentative consensus until we make our current defini-
tional criteria explicit, subject these criteria to critical
evaluation, and offer possible alternative criteria for our
colleagues to challenge and discuss. If we do not ap-
proach this difficult task, it may be done for us by others
outside the profession.
ACKNOWLEDGMENTS
A number of colleagues have read earlier versions of this paper
and have made thoughtful contributions. For their time and their
thoughts, I thank Tony Bashir, Lois Bloom, Phil Connell, Marc
Fey, Charlie Klim, Pat Launer, Jackie Liebergott, Shelly Lip-
schultz, John Muma, Naomi Schiff-Myers, and Linda Swisher.
Although I have attempted to take their comments into account,
this paper does not necessarily represent their views on the
topic.
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