SPECIFIC LANGUAGE IMPAIRMENT (SLI)

 In 1822, Gall published a description of children who had clear

problems in language but did not display the characteristics of other
known disorders.
 Vaisse (1866) introduced the term ‘congenital aphasia’ and applied it to
these children.
 However the German literature used the term (translated into English)
‘hearing mutism’ (Coen, 1886). Subsequently, the terms ‘congenital
auditory imperception’ (Worster-Drought & Allen, 1929) and congenital
verbal auditory agnosia (Karlin, 1954) also were used.
 Froschels (1918) - ‘delayed speech development’ as a descriptor of the
child’s deficit.
 McCall (1911) -‘congenital word deafness’ for those children who
completely lacked the ability to comprehend language.
 Gesell and Amatruda (1947) used the term infantile aphasia.
 The term developmental aphasia first used in the second decade of the
century (Kerr, 1917). At this time, authors began to use the terms
“expressive developmental aphasia” and receptive expressive
developmental aphasia to distinguish between deficits centering on
language production and those involving comprehension as well as
production.
 Beginning in the 1960s ‘dysphasia’ began to appear along with aphasia.
  By 1980s, authors choosing one of these two terms were more likely to
use developmental dysphasia (Hirson et al., 1987; Wyke 1978).

 Since the 1960s, the following terms have appeared in the literature:

# Infantile speech (Menyuk, 1964)

# Delayed speech
# Deviant language (Leonard, 1972)
# Specific language deficit (Tallal, et al 1981)

 The term specific language impairment (Leonard, 1981) along with

abbreviation SLI is the most widely adopted term at present, especially in
the literature.

Sub groupings of SLI ?????

 Rapin and Allen (1987) speculated that six possible grouping for children
with SLI might better describe the diversity of disorder.

1. Lexical syntactic deficit syndrome

2. Verbal auditory agnosia
3. Verbal dyspraxia
4. Phonological programming deficit syndrome
5. Phonological syntactic deficit syndrome
6. Semantic pragmatic deficit syndrome.

 In a later paper, Rapin (1996) noted that these six sub groupings
probably could be consolidated into three groups :
1. Expressive language disorder
2. Expressive receptive language disorder
3. Higher order processing disorder

 Ramsden and her colleagues (1997) delineated 3 sub groupings of

children with SLI, referring to them as
1. Expressive SLI
2. Expressive receptive SLI
3. Complex SLI (i.e. children who demonstrated problems learning lexical
syntactic semantic and pragmatic competencies but had no phonological
component to the disorder).

 DSM-IV (AMERICAN PSYCHIATRIC ASSOCIATION 1994) uses the term

developmental language disorder with the subtypes of ‘expressive” and
receptive and expressive.

 ICD-9-CM employs the terms ‘developmental aphasia’ and word deafness

as well as developmental language disorder.

Summary criteria given by DSM-IV of American psychiatric Association 1994.

 1. EXPRESSIVE LANGUAGE DISORDER

– The scores obtained from standardized, individually administered

measure expressive language development are substantially below
those obtained the standardized measures of both nonverbal
intellectual capacity and recent language development.
– The disturbance may be manifest clinically by symptom that include
having a markedly limited vocabulary making errors intense having
difficulty recalling words or producing sentences with
developmental appropriate length or complexity.
– The difficulties with expressive language interfere with academic or
occupation achievement or with social communication.
– Criteria are not met for mixed receptive expressive language
disorder pervasive developmental disorder,
– If mental retardation, a speech motor or sensory deficit, or
environment deprivation is present, the language difficulties are in
excess of those usual associated with these problems.

Mixed Receptive Expressive language disorder (American Psychiatric

Association 1994)
– The scores obtained from a battery of standardized individually
administered measures of both receptive and expressive language
development are substantial below those obtained from
standardized measures of non verbal intellectual capacity.
Symptoms include those for expressive language disorder as well
difficulty understanding words, sentences or specific types of words,
 such spatial terms.
– The difficulties with receptive and expressive language
significantly interfere with academic or occupational achievement
or with social communication
– Criteria are not met for pervasive developmental disorder.
– If mental retardation, a speech motor or sensory deficit, or
environmental deprivation is present, the language difficulties are in
excess of those usually associated with these problems.

Etiology
Researchers are frequently only in a position of identifying “risk factor”
that is, factors that tend to co-occur with the presence of SLI which can
only be thought as potential cause.
Risk factors include:-
Genetics
Difference in brain structure and function
Environmental variable
Linguistic and cognitive account
Processing factors.

A) GENETICS
 Genetic origins of SLI have probably been suspected for the years
by any one who has encountered families in which language
problems seem more common place than one might expect given
the relative exceptionality of language impairment.
  But many children with SLI come from families in which the - the
family members of proband (an affected person) has never had a
deficit in language ability.

But there are genetic connections, and now that we are aware of them
more evidences follow:-
 Several different types of studies are used to study the genetic basis of
those that are used to the greatest extent are “familial studies”, “Twin
studies” Pedigree studies.
 In fraternal twins (who are no more genetically related than a pair of
siblings and than average 50% of their genetic makeup),it would be more
likely that the result is environmental rather genetic influences.
 In pedigree studies, as many members as possible of a single proband’s
multigenerational family are examined in order to get an insight into the
pattern inheritance associated with the targeted characteristic or
disorder.
 Familial studies either use the questionnaire method or the direct
assessment method to assess the language skills. The latter has been
proven to be more useful.
 Further family histories of SLI may be more common among children
with expressive problems only than among those with both receptive and
expressive problems (Lahey and Edward 1995).

B) DIFFERENCE IN BRAIN STRUCTURE AND FUNCTION

 The prospect of difference in brain structure and function between
children with SLI, and those without has beckoned as a potential
explanation. This is illustrated by use of the term childhood aphasia.
 Two areas of the cerebral hemisphere in which such variations are seen
are the planum temporale and the perisylvian areas
 Detailed examination of these individuals brains after death showed an
atypical symmetry between the planum temporale on the left and the
one on the right.
 This pattern contrasted with the more typical symmetric arrangement in
which the planum temporal on the left is bigger than on the right, with
the larger size thought to reflect greater involvement in language
processing.
 Similar asymmetries, with left perisylvian larger than right hemisphere
have also been identified in autopsy studies
 The perisylvian areas, rather than the smaller planum temporale became
the focus of a series of studies conducted by Plante and her colleagues.

C) ENVIRONMENTAL VARIABLE

Environmental variables include physical, social, emotion or other aspects of

developing child’s surroundings from conception onward.

Two types of environment variable, have gained greatest amount of attention

for SLI.
a) Variable constituting the social and linguistic environment in children
with SLI in acquiring language.
b) Demographic variables, such as parental education, birth order and
family and socio-economics status that effect the environment in the
direct ways.
Leonard (1998) put forth a few generalizations about the environmental
variables.

1) Most of the evidence come from studies in which children with SLI are
compared with control children who are similar in age. These studies
suggest that their conversation partners (parents, other adults and peers
alike) make allowances for their diminished language skills and are
thus reacting to rather than causing the children problems.
For e.g. Mother of SLI may use shorter utterances (especially incases
where both comprehensions and expressions were affected or asked
fewer questions) during structural task compared to mothers of normally
developing children (Cunningham et al 1985).

Tomblin (1996) did a study to seen the effect of demographical data on

the occurrence of SLI and found that although there were trends in the
direction of children with SLI being later born and having parents with
fewer years of education than unaffected children, neither of these trends
was significant.

D) LINGUISTIC AND COGNITIVE ACCOUNT

 Leonard (1998) reviewed a wide field of linguistic and cognitive

 explanations of SLI dividing them into 3 categories. Specifically, he
considered 6 explanation of SLI focusing on deficits in linguistic
knowledge. Three on limitations in general processing capacity and 3
on graphic processing deficits.

E) PROCESSING FACTORS

Although children with SLI demonstrate typical nonverbal intelligence,

they also demonstrate cognitive impairments not exhibited on standard
intelligence measures information processing problems of children with SLI
occur with incoming information and in problem solving.

• Although interpretation of rapid, sequenced auditory input especially of

linguistic information, is difficult. Isolated non linguistic signal processing
is normal.

• Rapid, sequenced visual and tactile stimuli also difficult for children with
SLI to interpret.

• Short term auditory sequential memory for item order and problem
solving of complex reasoning tasks are affected in children with SLI
(Kamhi & Gentry 1990)

• Working memory is an process that allows for access to a small number

of items in conscious awareness. Incoming linguistic information is held
in working memory while the underlying meaning is found.

LANGUAGE DEFICITS IN CHILDREN WITH SLI

 Tools used for matching criterion during studies based on SLP include

 Mean length of utterance (to study morph syntactic structure)

 Mean number of non nuclear predicate produced per utterance (or) the
mean number of open class words used per utterances.
 Measure of phonology
 Expressive vocabulary
 Comprehension ability

The Language characteristics of SLI

Early Lexicon:
 Children with SLI appear to be late in acquiring their first words.

• Most of evidence comes from early case studies like Reader (1940)-
observed child who found it difficult to produce 1st word until 4 years
Werner (1945)reported of child who did not use first word until after 5
years of age.

• A retrospective study of 71 children with SLI was conducted based on

parental report. Tranuer indicated an average age of first words is almost
23 months compared with age of almost 11 months reported by parents of
normally developing children.

• The finding that children with SLI acquire their first words at a later
 expected age is not surprising, but it is not logically necessary.

The lexical types in the vocabulary include:

 General lexical categories (e.g. Names of objects, substances, animals –
55%)
 Word referring to actions – 12%
 Word referring to properties – 12%
(Leonard, Camarata, Rawan & Chapman, 1982)

 By the time children with SLI begin to produce multi word utterances,
their lexical abilities are not so easily characterized as matching those of
younger normally developing children.
 Verbs, in particular, begin to show deficiencies. Walkins, Rice and Moltz
(1993) found that preschool age children with SLI used a more limited
variety of verbs than age matched controls, though they used with high
frequency (e.g. go, get, put, want)

Lexical learning in the Preschool years

• In a study conducted by Leonard, Schwartz and their colleagues

(1983,1982, 1989) comparisons were drawn between 3-4 years old
children with SLI in single word production level and younger normally
developing children with comparable lexical sizes and utterance lengths.

• The findings of these studies showed that during the period of

development lexical acquisition in children with SLI was slow

• In one study, they did not extend these words to new references to the
 degree in the control children, but some appropriate extensions were
observed and in another study, so were overextensions.

• Acquisition of morpho- syntax appeared to be their biggest obstacle.

• Dollaghan (1987) studied a group of 4 to 5 old children with SLI showing

prominent deficits in the production of morpho syntax.

• Rice Buhr and Nameth (1990) The children with SLI showed poorer over
all mapping ability on a comprehension task than did both age control MLU
controls. The names of actions were especially difficult for each group of
children.

LEXICAL ABILITIES DURING THE SCHOOL YEARS

• Study done by Oetting Rice Swank (1995) revealed that the school age
child with SLI learned object names almost as well as did age controls, but
their learn action names fell well below that of their same age peers.

• The lexical limitation most frequently identified in the literature on

school children with SLI is a “word finding” problem that is a problem in
particular word called for in the situation (e.g. German 1987, Leonard,
1995)

• Difficulties have been variously described as “lexical look up” problems

(Menyuk) and problems involving “delayed speed of word retrieval”
 (E.Schwartz, Solot)

According to the clinical literature, the chief symptoms of word finding

problems

• Usually long pauses in speech

• Frequent circumlocution

• Use of non specific words (such as it or stuff)

• Naming errors

Anderson (1965) examined naming response times in children with SLI.

A group of school age children with SLI named pictures of a common
objects with slower response times than a group of age controls.

• Similar findings were observed by Nystrom et al (1992) with stimuli that

included color and shape names

• Studies done from the 1960s – 1970s have revealed that age of first word
combinations appears to be later in children with SLI than in normally
developing children. Studies have reported word combination that reflects
rather narrow meaning in children with SLI (Leonard, 1984)

Morphosyntax

(1) syntactic structure and (2) grammatical morphology.

 Syntactic structure- structural relationship between constituents.

 Grammatical morphology – Close class morphemes of the language,

both morphemes seen in inflectional morphology (e.g. “play”, “played”)
and derivational morphology (e.g. “Fool”, “foolish”) and functional words
such as articles and anxuliary verbs.

Syntactic structure

• Menyuk (1964) collected spontaneous speech samples from children with

SLI aged 3-5 years and normally developing children matched according
to age. The results indicated that a greater number of age controls
showed evidence of transformations, whereas a greater number of
children with SLI deviated from adult grammar. Omissions were the
most common type of deviation.

• Lee (1996) found that children with SLI did not use some of the
constructions seen in the speech of normally developing children,
suggesting that children with SLI possessed at a more restricted set of
syntactic rules.

• Ingram (1970, 1973) compared children with SLI with a MLU matched
children. The 2 groups were found to be similar in the syntactic rules
reflected in their speech, with a few important exceptions. The children
with SLI did not use major syntactic categories (e.g. noun, verb embedded
sentence) in as many different sentence contexts, on average as the MLU
controls.
Grammatical Morphology

 Kessler (1975) examined SLI children’s use of many of grammatical

morphemes (non plurals progressive –ing past tense –ed, copula ‘be’
forms) studied in young normally developing children by Brown (1973).

• A ranking of these morphemes according to percentage of correct use in

obligatory contexts yielded sequence that fall well within the range of
sequences reported for typical children and like this study, other study
had been done by Ingram (1970, 1973) which reported no difference
between SLI children and MLU controls.

• Leonard, Bortolini, Casselli and Sabbadini (1992) found higher

percentage of use in obligatory contexts by MLU controls for the plural
inflection, regular past inflection, third person singular inflection and
copula be forms. Differences in the same direction for articles and
irregular past form failed to reach statistical significance.

• A different impression emerged from a case study by Gopnik (1990) He

conducted study and said that children with SLI had no knowledge of
grammatical role of morphemes based on his study on 8 year old children
with SLI who exhibited errors on many inflections and function words
involving tense definiteness person, number and gender

• Errors were not limited to omissions of forms from obligatory contexts,

inappropriate productions of these morphemes were also seen.
 Phonology

Phonological deficits rarely occur alone. During the preschool years, if

child exhibit deficits in morphosyntax and lexical skills, there is almost
invariably weakness in phonology as well. If children are identified first
on the basis of phonological problems a majority will also show problems
in other areas of language (e.g. Paul & Shriberg 1982).

 Children with SLI are late in acquiring the segments of the language.
Segment that are acquired early by normally developing children (e.g.
/n/, /m/, /b/, /w/) are like the first to be acquired by children with SLI,
at a later age.
 Segments that are acquired later by normally developing children
(e.g./s/v/) can continue to be difficult for children with SLI

Distinctive features
 An obvious shortening of segment analysis is that each consonant and
vowel treated as if it were independent of all others. Yet clinicians and
researchers recognize that some segments are more similar than others
and hence more problems might easily be due to problem with the shared
characteristic.
 To capture this information investigators began to apply distinctive
feature analysis the early 1970s. The most frequently adopted distinctive
feature system was that Chomsky and Halle (1968) in which similarities
and differences are represented by binary values.
 The distinctive feature patterns represented in the speech of children
with resemble those seen in the speech of younger normally developing
children. However, there are two possible differences.

 Menyuk (1968) observed that once segments carrying (+ strident) appear

in the speech of normally developing children, this feature is relatively
resilent, even if other features in the target sound are in error. However,
data from Leonard (1973) and Mc Reynolds and Huston (1971) suggest
that children SLI retain (+strident) least often.

 Whereas errors such as Su/and/tsu/or/t/u/ for shoe might be most

likely for typical children, errors such as /tu/ for shoe might be seen
more often among children with SLI.

 The best documented difference between children with SLI and younger
normally developing children concerns (+voice). Although children with
SLI are not as proficient as their same age peers in their ability to produce
voicing contrasts (eg coal-goal) (Catts & Jensen, 1983) this aspect of
phonology seems to be a relative strength in these children, at least in
word initial or prevocalic position.

• Ingram (1981) observed that prevocalic substitution of (+voice) for (-

voice) (e.g. /gol/for coal) was a frequent error only in the normally
developing group.

• Similar findings have been reported when the voicing contrast was
measured in terms of voice onset time (VOT). Farmer and florance
 (1977) found that a group of children with SLI showed VOT values for
word initial stops that approximated those seen for normally developing
children of the same age.

Unusual errors

• It appears that children with SLI are more likey than younger normally
developing children to produce errors of an unusual nature (Leonard
1985) some of these are cases of presumably later developing sounds
replacing presumably earlier developing sounds (e.g. v/for /d/)
(Grunwell, 1981, Leonard and Brown 1989)

• Another unusual error pattern is seen when the child’s production

constitutes an addition of an adult form e.g. Nasal added to the initial
form D Ingram (1976) or in addition of nasal final position or nasal
inserted before alveolar stops (e.g./ tond/for/toad/ (Edwards and
phonology Benhardt).

• Some unusual errors involve the use of consonants not found in the
ambient language. Example of SLI with speaking English include use of
nasal frication and snorts, alveolar fricatives, ingressive lateral and
alveolar fricatives.

Pragmatics

 The pragmatic skills of children with SLI have been examined primarily
within dialogue and within narrative discourse.
 Within dialogue:
 Requesting and commenting
 Presuppositional referencing
 Verbal and non verbal turn taking
 Responding

Requesting and commenting

• Overall findings indicate that requesting and commenting are apparent in

the discourse of children with SLI by approximately 3 years-9 years of
age.

Referencing presuppositions

• Speakers make assumptions about what their listeners know and do not.
Presuppositions refer to speakers back grounding and for grounding of
information for the listeners

• Shyder (1978) examined the Presuppositional behavior of children with

lang disorder and children with normal language development at one
word stage.

• In contrast to children with normal language, the children with language

disorder used more non linguistic means when expressing relationship.

• Green field (1982) examined the presuppositions of children with

language disorder who were beyond the one word stage. They found that
 both disordered (SLI) children and normal language matched controls
they used changing elements on the situation.

Further they observed a developmental progress in the linguistic

strategies by children with normal language, but more than half language
disordered children use old information.These studies reveal that
children with SLI demonstrate, basic Presuppositional knowledge. They
foreground new information and background old information in a
manner that allows them to construct informative messages. However in
contrast to children with normal language, beyond the one word stage
language disordered children express these presumptions in a manner
that is not typical of their language structural level.

Verbal and non verbal turn taking

 In general, it appears that, even at early stage of language development,

SLI children demonstrated the ability to relate verbally to previous
discourse.

 The linguistic profiles they present, however incorporate behaviors that

are different from those used by normally developing children.

 Craig and Evens (1989) investigated the verbal and nonverbal

characteristics of successful and unsuccessful turns produced by boys
with SLI girls and boys with normal language matched for age and
language. They found that children with SLI differed from those of
 children with normal language in the following ways; children with SLI
produced significantly less other-directed speech, fewer multiutterance
turns and less highly timed turns than their age mates.
 Several other studies suggest that most behaviors serving a turn
regulation function are essentially intact, some differences may result
from slow processing, consistent with children’s receptive language
deficits.

Responding
 Gallaghar and Barton (1978) examined responses of SLI children to the
neutral “what”? form of requests for clarification.
 The children seemed to recognize that they needed to do something to
their utterance to clarify the message for their partner when requested to
do so.
 Brenton et al (1986) examined the response of children with SLI to
requests clarification and found that the subjects with SLI recognized the
obligatory nature of request and again no response rates were low for
both subjects with language disorders and age matched controls with
normal language. The translation of the response into an appropriate
linguistic form distinguished the SLI and normal language subject groups.
The children with SLI produced more inappropriate responses than the
children with normal language. SLI children were not able to add
information to their recordings and did attempt verbally probe the nature
of the problem experienced by the listener as normally developing
children.
 ASSESSMENT OF CHILDREN WITH SLI

 Early identification of children with SLI

 Identifying SLI at an early age would be a lot easier if all normal children
began to speak about the same time.
 There is nothing obvious that distinguishes these children late talkers
from other typical children.
 The option of waiting until a child reaches 3-4 years of age before seeking
assistance seems too risky.
 High percentages of preschoolers with SLI continue to experience
problems through childhood and beyond.
 If these children could be identified even earlier and their language
development facilitated, their outcomes must be considerably better.

This work was aided by the development of 2 psychometrically strong yet

high practical vocabulary checklists.
1) The McArthur Communicative Development Inventories (Pethick et
Relly 1993)
2) Language Development Survey (Rescorla 1989)

 The checklist contains words that have been documented in children’s

speech in early ages, parents respond by indicating which of the words
their child comprehensive and or produces.
 Assessment will usually include an interview with the child’s caregiver,
observation of the child in an unstructured setting, a hearing test, and
standardized tests of language and nonverbal ability.
 There is a wide range of language assessments in English. Some are
restricted for use by speech and language professionals.
 A commonly used test battery for diagnosis of SLI is the Clinical
Evaluation of Language Fundamentals (CELF) (Semel, Wiig & Secord,
2006).
The CELF-4 is tool for the identification, diagnosis and follow-up
evaluation of language and communication disorders in students 5-21
years old.

The test is administered individually and used by speech and language

pathologist primarily, yet also used by school psychologist, special
educators, and diagnosticians.
CELF-4 is a standardized instrument with a comprehensive examiner’s
manual.

The CELF-4 is designed as a four level assessment process:

1. Identify whether or not there is a language disorder.
2. Describe the nature of the disorder.
3. Evaluate underlying clinical behaviors.
4. Evaluate language and communication in context.

The instrument is comprised of 16 subtests, a pragmatic profile and

observational rating scale. The subtests give a description of language
across modalities and content areas.
 Assessments that can be completed by a parent or teacher can be useful
to identify children who may require more in-depth evaluation. The
Grammar and Phonology Screening (GAPS) test is a quick (ten minute)
simple and accurate screening test developed and standardized in the UK.
It is suitable for children from 3;4 to 6;8 years;months and can be
administered by professionals and non-professionals (including parents)
alike (Gardner et al., 2006).

 The Children’s Communication Checklist – 2 (Bishop, 2003) is a parent

questionnaire suitable for testing language skills in school-aged children.

Binay Kant (2004) developed an assessment protocol for children with SLI to
assess and identify the subgroups in children with SLI. The following
tests were administered to aid an diagnosis and sub grouping of SLI

• Kannada Language Test (KLT)

• Reading Readiness Test (RRT)

• Test of articulation in Kannada

 Vocabulary skills
 Auditory discrimination skills.

• Pragmatic abilities questionnaire.

• The results obtained from above test battery indicated a significant

 difference between normative values and present study on KLT, RRT and
KAT.
 All children found to have deficits in overall language skills including
receptive, expressive skill language and subtests of semantic and
syntactic skills. The receptive skills were found be better than expressive
skills. They also had deficits in articulation abilities auditory
discrimination task.
 Gurpreet (2003) studied cortical evoked potentials namely LLR and MMN
were investigated in children with SLI and found that –Amplitude of P
100 - N 250 wave complex, LLR was significantly attenuated in SLI group.
Peak amplitude of MMN was significantly reduced in SLI group. Hence the
amplitude measure of P100 – N 250 complex and MMN be used to
problems due to auditory processing deficits. Thus, this study offers a
new diagnose method for early identification of SLI.

What is the relationship between ‘Late talkers’ and SLI

 The child who is late to begin talking, both in terms of acquisition of first
and production of first word combinations, may be at particular risk for
the development of SLI.

 The proportions often discussed are between 25 to 50% of children

diagnose late talkers’ eventually are diagnosed as SLI prior to age 3 is
now possibility.
 Rate of vocabulary development and use of communicative gesture being
 the prime language behavior data collected in studies of ‘late talkers’.
They have also been shown to demonstrate less mature development of
their phonological systems
 (Rescorla and Bernstein Ratner, 1996) symbolic play behaviors (Rescorla
and Gosens 1992) and limited socialization skills (Paul et al 1991) when
compared with age matched, normally developing peers.
 Two year old ‘late talking' children who were more likely to catch up with
their peers by age 3 were children who utilized gestures to enhance their
limited verbal output (Thal et al 1991).
 Leonard (1998) noted that point to a significant proportion of ‘late
talkers’ matching up with their age matched peers by the time they reach
the early school year should not suggest that early intervention is not a
useful and clinically appropriate behavior with this population.
 As noted by Walkins (1994) and rice (1994) research has demonstrated
at least three features that appears to be shared with children diagnosed
as SLI.
 There is a great deal of variability of language performance within the
population this heterogeneity can affect the severity of language problem,
the area of learning affected, and the modality or modalities affected.
 We also know that children diagnosed with SLI are likely to demonstrate
social interactive problems that manifest themselves later as
conversational and other pragmatic deficits.
 There is sufficient literature to suggest that the problem of SLI is ongoing.
By the one diagnosed by SLI demonstrate problem in reading and writing.

References
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Bopston Pearson education company
 Broston: Pearton Education Company.
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Diego Singular publishing Graus
 Leonard, LB (1998) children with specific language impairment London
MIT press
 Nelson NW (1998) childhood language disorders in context infancy
through adolescence (2nd ed) Viacom Company
 Paul.R. (2001). Language disorders from infancy theory Adolescence
assessment and intervention (2nd ed )