hall1978

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A F O L L O W - U P S T U D Y O F C H I L D R E N W I T H 
A R T I C U L A T I O N A N D L A N G U A G E D I S O R D E R S 
Penelope K. Hall and J. Bruce Tomblin 
University of Iowa, Iowa City 
Thirty-six subjects, 18 language-impaired and 18 articulation-impaired children, 
were followed up with respect to communication skills and educational perfor- 
mance 1,3 to 20 years after their initial contact with the Speech and Hearing Clinic. 
According to their parents, nine language-impaired subjects continued to exhibit 
communication problems as adults, compared to only one of the articulation-im- 
paired subjects. Standardized educational testing conducted while the subjects were 
in elementary and secondary schools indicated that the language-impaired group 
consistently achieved at a lower level than the articulation-impaired group, partic- 
ularly in reading. Differences between the groups were also exhibited in the types 
of postsecondary education attempted by the subjects. Clinical, educational, and re- 
search implications of these results are discussed. 
Parents and professionals in other fields frequently ask speech-language pa- 
thologists what the long-term outlook is for children with language and ar- 
-ticulation disorders. Unfortunately, such information comes only with exten- 
sive clinical experience that may be based on unsystematic observations. Al- 
though the Task Force on Learning Disabilities of the American Speech and 
Hearing Association (1976) recognized the need for this type of research, the 
literature reveals few studies dealing with the follow-up of such cases beyond 
elementary school age. DeAjuriaguerra et al. (1976) published the most exten- 
sive follow-up to date on children with aphasia. These investigators followed 
children for 2 to 4 years, with the oldest child reaching 12 years of age. Their 
study revealed widespread deficits in intellectual and academic development 
which persisted throughout the period of time the children were observed. 
Weiner (1974) described an adolescent who had initially been evaluated 12 years 
earlier. His client continued to demonstrate many difficulties with syntax and 
articulation. Weiner noted that these difficulties affected not only the subject's 
communication, but also his educational and social adjustment, He projected 
that the communication problems would affect the youth's future economic 
potential. Garvey and Gordon (1973) reported a follow-up study of British 
children with disorders of speech development. Interpretation of this study is 
difficult because the population was heterogeneous with regard to communica- 
tion disorders. Among the subjects reviewed and tested by Garvey and Gordon 
227 
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228 JOURNAL OF SPEECH AND HEARING DISORDERS XLIII 227-241 May 1978. 
were 25 students who were attending regular primary and secondary schools. 
Twelve had receptive and expressive language skills below the norm for their 
age. According to school records, nine of the 12 students were also experienc- 
ing academic difficulties in reading and writing. 
All of these studies show that the child with a language problem will most 
likely be confronted with difficulties in academic performance. The extent 
and persistence of these difficulties into adolescence and adult life have not 
been well documented. 
The provision of clinical services to individuals with articulation and lan- 
guage problems is frequently based on the notion that these communication 
problems contribute to educational, vocational, and social difficulties. Because 
of the central place this notion has in the rationale for the provision of clinical 
services, there is a need for information pertaining to the academic skills of 
children with such communication disorders. A need also exists for data con- 
cerning the eventual vocational status and communicative abilities of these 
individuals as adults. Because of these needs, we have conducted a follow-up 
study of children seen at the University of Iowa Speech and Hearing Clinic 
who exhibited language or articulation problems. We were specifically in- 
terested in the communication status of individuals with language disorders 
as they progressed through formal education and became employed. 
M E T H O D 
The data reported in this study are part of a comprehensive follow-up of 
children with language or articulation disorders seen in the University of Iowa 
Speech and Hearing Clinic between 1955 and 1962. In all, 281 children were 
identified from clinic records and 188 parents of these former clients were 
located and responded to a questionnaire. This report concerns 36 of these 
past clients. 
Follow-Up Information Obta ined 
As part of this investigation, educational, social, and occupational informa- 
tion pertaining to these former clients was obtained. Information regarding 
their communication abilities and treatment history as children and their com- 
munication status as adults was also collected. This information was received 
from two sources, the parents of the clients and a standardized achievement 
test . 
A questionnaire was sent to the parents requesting information on their 
perceptions of the subject's present communication status, specifically ques- 
tioning the presence of a communication deficit and its characteristics in their 
adult offspring. Questions concerning the subject's educational history, the 
chronology of speech and hearing services, and current vocation were in- 
cluded. 
Standardized achievement test results obtained while in elementary and sec- 
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HALL, TOMBLIN: Follow-Up Study 229 
ondary schools were acquired from the Iowa Testing Service files for many of 
the past clients. These standardized achievement tests were the Iowa Tests of 
Basic Skills (ITBS) (Lindquist and Hieronymus, 1956) and the Iowa Tests of 
Educational Development, Forms X-5 and Y-5 (ITED) (Lindquist and Feldt, 
1972). The ITBS and ITED are sensitive indexes of educational achievement 
(McLaughlin, 1950; Orton, 1958; Scannell, 1958; Robertson, 1959). 
The Iowa Tests of Basic Skills provide measures of certain academic skills 
from the third through the eighth grade. The complete test battery contains 11 
subtests that are combined into four composite scores and a total score. The 
composite and total scores were used as data for this study. The publishers of 
these tests did not provide a composite score for reading, but rather reported 
only two reading subtest scores. To reduce the number of variables to be 
analyzed, a composite score in reading was computed for the subjects in this 
study. 
The Iowa Tests of Educational Development, Forms X-5 and Y-5, contain 
nine subtest areas and are administered to students in the ninth through the 
twelfth grade. The standard reporting of these test scores provided only the 
subtest scores and an overall total score that were derived from all subtests. 
Again, to reduce the number of variables for analysis, certain subtests were 
pooled to form composite scores. This process resulted in the following four 
separate measures of academic performance: background, correctness of ex- 
pression, quantitative thinking, and reading, and one total score. 
Subjects 
The 36 subjects were placed into either a language-impaired (LI) or an 
articulation-impaired (AI) group. The LI group contained 18 children with 
evidence of a language disorder at the time of their evaluation in our clinic. 
Since the diagnostic category of language disorder was not common at the 
time these children were seen, this descriptionhad to be made by the authors 
using information in the clinic records. The criteria used to place a child in 
this descriptive category were 
1. hearing sensitivity within normal limits, 
2. measured intelligence of 80 or above, 
3. evidence of two or more of the following language deficits: 
a. scored one standard deviation or more below the mean for age on mean length 
of response (McCarthy, 1930; Templin, 1957). 
b. scored one standard deviation or more below the mean for age on structural 
complexity score (Templin, 1957), 
c. achieved a vocabulary age one year or more below chronological age on a vo- 
cabulary test (Ammons and Ammons, 1948; Dunn, 1959), 
d. exhibited a 20 or more point spread between the performance and verbal sub- 
tests of the WISC (Wechsler, 1949), 
e. received a diagnostic impression of speech or language retardation. 
In addition we found that all subjects who met the above criteria presented 
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230 JOURNAL OF SPEECH AND HEARING DISORDERS XLIII 227-241 May 1978 
art iculatory performance that was at least one standard deviation below the 
mean for their age and sex using either the diagnostic or screening test norms 
of Templ in (1953) and Te m pl i n and Darley (1960). 
T o study the relat ionship between the language deficit and educational 
growth and at ta inment , a comparison group was necessary since for some mea- 
sures no norms were available. In those instances in which norms were avail- 
able, we were also concerned with the comparabil i ty of our sample of LI 
children with a general normative sample. Most of these LI children were 
brought to our clinic by their parent~ from long distances and we can, there- 
fore, assume that they came from families with the motivat ion and the means 
to seek help. In addition, the parents of these children part icipated in the 
study by responding to a questionnaire. By comparing these children to an 
overall educational achievement norm, we might underest imate the relation- 
ship between language and achievement. T o resolve this problem, an articula- 
t ion-impaired group was selected from the same pool of clients used to provide 
the language-disordered subjects. This comparison group had 18 children with 
ar t iculat ion problems, but without language problems. Criteria for selection of 
the ar t iculat ion group were 
I. hearing sensitivity within normal limits, 
2. measured intelligence of 80 or above, 
3. articulation scores below the mean for age (Templin, 1953; Templin and Darley, 
1960), 
4. no exhibition of the langlaage criteria listed under Item 3 of the criteria for lan- 
guage disorder, 
5. a diagnostic impression of articulation or functional articulation disorder. 
Comparability Between the AI and LI Groups. T o permit a comparison be- 
tween the LI and AI groups with regard to their learning performance and 
communicat ion skills, the two groups were contrasted in the f611owing areas: 
age, sex, socioeconomic status, intelligence, and receipt of therapy services. 
Criteria for Grouping Subjects. Figure 1 contains the criteria used to form 
the LI group. Wi th in the group of 18 language subjects, 50% met two of the 
stated language criteria, 33% met three, 11~o met four, and 6% met all five. 
Age and Sex Distribution. At the time of the initial evaluation (1955-1962) 
the mean age of the LI subjects was six years and one month, while the mean 
age of the AI subjects was six years and four months. When the parents re- 
turned the quest ionnaire (1973-1975) the mean age of the LI subjects was 22 
years and three months, and the mean age for the AI group was 23 years and 
zero months. 
T e n females and eight males were in the LI group while seven females and 
11 males were in the AI group. Chi-square testing of the differences in distribu- 
tion of males and females of these two groups was found to be nonsignificant. 
Socioeconomic Status. The socioeconomic status of most families was de- 
termined at the time of the initial evaluation using the Index of Status Char- 
acteristics (Warner, Meeker, and Eells, 1949). Twelve of the LI subjects and 
13 of the AI subjects were middle-class, while six LI subjects and two AI sub- 
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HALL, TOMBLIN. Follow-Up Study 231 
CRITERIA MET BY LANGUAeE SUBJECTS 
OIAeNOSTIC IMPRESSION 
OF SPEECH OR 
LANGUAGE RETARDATION 
2 0 POINT SPREAD 
ON WlSC 
E 
w REDUCED VOCABULARY AGE 
u 
REDUCED SC$ 
REDUCED MLR 
�9 �9 �9 �9 �9 �9 �9 �9 r �9 �9 
�9 �9 �9 �9 �9 
�9 �9 �9 �9 �9 �9 
�9 �9 �9 �9 �9 �9 �9 �9 �9 �9 
�9 �9 �9 �9 �9 �9 �9 �9 �9 �9 �9 �9 �9 �9 �9 �9 �9 
I 1 I 1 I I I I I I I 1 1 I I I 1 I 
I 2 3 4 5 6 ? 8 9 I0 II 12 13 14 15 16 17 |S 
SUBJECTS 
Figure 1. The number of criteria for language disorder met by the 18 language-impaired subjects. 
jects were lower-class. This information was not obtained for three of the 
art iculat ion subjects. A chi-square testing of the differences in dis t r ibut ion of 
socioeconomic status of these two groups was found to be nonsignificant. 
Intelligence. When the intellectual assessments were obtained at the time 
of the original evaluation, various test tools were used. The number of sub- 
jects with available test scores on each test or subtest thus differed, as indicated 
on Table 1. T he mean intelligence quot ient scores on the performance port ion 
of the WISC were nearly identical for those tested from both groups, as was 
the range of scores from which the mean was computed. There were clear dif- 
ferences between the performances of the two groups on the Verbal section of 
the WISC and the Stanford-Binet, Form LM, which are both language loaded. 
The data on age, sex, socioeconomic status, and intelligence strongly support 
the similarity between these two groups. The equali ty of intelligence is a par- 
ticular prerequisi te for comparison of their later academic performance. 
Receipt and Type of Therapy Services. The parents were asked through the 
quest ionnaire to indicate whether their son or daughter had ever received 
speech therapy, and if so, what the goals had been. Fifteen of the 18 LI sub- 
jects reportedly received remediat ion as youngsters, as had 13 of the 18 AI 
subjects. The remediat ion was conducted pr imari ly within the school setting, 
with several subjects receiving services through private and university clinics, 
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232 JOURNAL OF SPEECH AND HEARING DISORDERS XLIII 227-241 May 1978 
TABLE 1. Comparison of intelligence test results between language-impaired 
and articulation-impaired subjects. 
I 
Language Articulation 
Intelligence Test Subjects Subjects 
Stanford-Binet, Form LM 
Number 7 9 
Mean IQ 94 119 
Range 82-103 98-133 
WISC-Verbal 
Number 8 6 
Mean IQ 88 110 
Range 70-109 100-120 
WISC-Performance 
Number 8 8 
Mean IQ 109 108 
Range 94-131 87-124 
WISC--Full-Scale 
Number 9 6 
Mean I q 102 109 
Range 80-129 100-120 
Other (Merrill-Palmer, Leiter, or Vineland) 
Number 4 1 
Mean IQ 102 108 
Range 90-112 - 
and through clinicians in private practice. Three of the LI group and five of 
the AI group were reported to have received no clinical speech services. 
All of the parents listed various speech sounds on which their child had 
worked in therapy, indicating a remedial emphasis on articulation skills. None 
of the LI subjects were described as having received language remediation. 
Six parentsfrom that group, and three from the AI group did not describe 
their offspring's therapy goals or stated that they were unable to recall this 
information. 
RESU LTS 
The two groups' of subjects adult communication skills and educational 
development were compared. 
Communication Status as Adults 
Nine of the parents (50%) of the LI group believed that their son or 
daughter continued to exhibit some type of problem with articulation and 
language skills. In contrast, only one of the AI subjects had a persistent prob- 
lem with articulation. 
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HALL, TOMBLIN: Follow-Up Study 233 
One of the nine LI subjects who had continuing difficulties was described 
as having problems with only articulation skills while three others were de- 
scribed as having problems with articulation as well as language skills. Four 
LI subjects were described as having problems with language skills but lacking 
articulation problems. One parent within each group did not respond to this 
question. It must be stressed that these statements about communication dif- 
ficulties were parents' perceptions and not professional clinical observations. 
Educational Data 
The two types of educational data that were obtained regarding the 36 sub- 
jects' academic achievement are (1) parents' report of the highest level of edu- 
cation achieved by their son or daughter, and (2) standardized results from the 
Iowa Tests of Basic Skills (ITBS) and the Iowa Tests of Educational Develop- 
ment (ITED). 
Level of Formal Education. Figure 2 presents a summary of the parents' re- 
port of level of formal education attained by the subjects in the two groups. 
All 36 subjects were completing or had completed high school. Despite the 
high percentage of subjects who completed high school, a different pattern 
developed at the postsecondary level, with fewer language subjects than ar- 
ticulation subjects obtaining higher education. 
CURRENTLY DOING GRADUATE 
WORK 
COMPLETED B A I B S 
CURRENTLY IN COLLEGE 
COMPLETED 21/Z YR. OF 
Z COLLEGE 
~_. COMPLETED JUNIOR COLLEGE 
 C URRENTLY IN HIGH SCHOOL 
Id 
J 
SUMMARY OF FORMAL EDUCATION 
[ ] LANGUAGE SUBJECTS �9 [ ] 
�9 ARTICULATION SUBJECTS �9 �9 �9 �9 [ ] [ ] 
�9 �9 �9 �9 [ ] [ ] [ ] 
�9 �9 [ ] 
�9 �9 [ ] 
[] 
[] [] 
J t J I I I 1 I I I I l 1 I I J I t 
I 2 3 4 5 6 7 8 9 I0 II 12 13 14 IS. 16 17 18 
SUBJECTS 
Figure 2. S u m m a r y of f o r m a l e d u c a t i o n a c h i e v e d b y t h e 18 l a n g u a g e - i m p a i r e d s u b j e c t s a n d t h e 1 8 
a r t i c u l a t i o n - i m p a i r e d sub jec t s . 
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234 JOURNAL OF SPEECH AND HEARING DISORDERS XLll[ 227-241 May 1978 
Academic Performance Indicated by Standardized Tests. Resul t s of the I o w a 
Tes t s of Basic Skills a n d the I o w a Tes t s of E d u c a t i o n a l D e v e l o p m e n t were 
o b t a i n e d for a m a j o r i t y of the subjects in each g r o u p f rom G r a d e 3 t h r o u g h 
G r a d e 12. Since these tests are a d m i n i s t e r e d by schools on a v o l u n t a r y basis, 
some of the 36 subjec ts h a d no t b e e n g iven these tests. 
Iowa Test of Basic Skills Data. T a b l e 2 con ta ins the m e a n c o m p o s i t e a n d 
to ta l scores for each g rade level for the two groups . T h e s e d a t a are based o n a 
g r a d e - e q u i v a l e n t scale in w h i c h the first d ig i t r ep re sen t s a g rade level a n d the 
second ind ica t e s the m o n t h w i t h i n the g rade us ing a 10-month year. T h u s , 
a score of 65 w o u l d i n d i c a t e p e r f o r m a n c e at the m i d y e a r s ix th -grade level. 
TABLE 2. Mean grade equivalent scores and difference score (DifferencesD) in pooled standard 
deviation units for four composite areas and total composite scores of the Iowa Tests of Basic 
Skills for language-disordered (Language) and articulation-disordered (Articulation) children. 
Grade Group Number 
Composite Area 
Work Total 
Reading Language Study Mathematics Score 
Language 9 33.22 31.00 30.89 30.67 31.89 
3 Articulation 13 34.65 38.69 36.69 38.62* 35.69 
Difference 
scoresD - 0.12 0.21 0.21 0.36 0.40 
Language I I 39.73 45.63 37.91 45.00 42.64 
4 Articulation 15 49.93* 52.27* 52.13" 52.00* 53.80* 
Difference 
scoresD - 0.80 0.74 0.42 0.56 1.02 
Language 10 47.25 52.80 56.50 55.90 51.20 
5 Articulation 16 62.56* 63.37* 67.06* 64.94* 66.69* 
Difference 
scoresD - 1.29 0.84 0.84 1.0 1.47 
Language 10 56.50 65.00 68.40 65.90 61.10 
6 Articulation 16 72.03* 74.31" 7 7 . 3 1 " 77.44* 76.75* 
Difference 
scoresD - 0.96 0.62 0.59 0.94 1.26 
Language 10 62.05 66.30 72.10 70.33 68.38 
7 Articulation 17 84.53* 84.82* 85.06* 83.80 87.63* 
Difference 
scoresD - 1.23 1.04 0.79 0.83 1.17 
Language 10 78.27 82.45 86.09 84.40 84.00 
8 Articulation 17 95.88* 92.05 97.59 97.20 98.75* 
Difference 
scoresD - 0.96 0.48 0.74 0.78 0.88 
Mean Difference Score 0.89 0.65 0.60 0.83 1.60 
i 
*Significant difference (pgrade level. The results of 
these tests are contained in Table 2. The selected 0.05 level of confidence en- 
compasses all four comparisons at each grade level. Significant differences were 
found for reading at all grades except the third. Differences were also found 
for work study and language at Grades 4, 5, 6, and 7 and mathematics at 
Grades 3, 4, 5, and 6. Inspection of the pa t te rn of differences for composite 
tests across grades indicates that reading and mathematics were topics where 
differences were most frequently found. Fur ther informat ion about the relative 
contr ibut ion of each composite test can be obtained by looking at the magni- 
tudes of the mean difference scores in each composite area summing over the 
six grades. Again, reading and mathematics were the two areas with the largest 
difference values. 
While the inferential tests and difference scores reveal the varying degrees 
of academic l imitat ion in the LI group relative to the AI comparison group, 
this view of the data does not contain information about the strengths and 
weaknesses of the LI group on a more absolute basis. T o make this com- 
parison, the mean grade equivalent scores contained in Table 2 were con- 
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236 JOURNAL OF SPEECH AND HEARING DISORDERS XLIII 227-241 May 1978 
vetted to standard scores. This was necessary because the variance in the 
normative population of each composite area was different. Therefore, a 
variation of 10 points on one subtest would represent a substantial change in 
ability on one subtest while l0 points would be much less on another. Stan- 
dard scores were computed by subtracting the mean composite scores in Table 
2 from the normative mean and dividing this difference by the standard devia- 
tion of the normative population. These scores provide data that can be com- 
pared across subtests. These data are contained in Table 3. A value of zero 
in these data indicates performance at the mean. Positive and negative values 
signify performance above or below the mean with a value of _ 1 being 
one standard deviation above or below the mean. 
TABLE 3. Per formance of language-disordered and ar t iculat ion controls on the 
Iowa Tests of Basic Skills in terms of s tandard scores. 
i i 
Grade Group Reading Language Work Study Mathematics 
3 Language 
Art icula t ion 
Language 
Art icula t ion 
Language 
Art iculat ion 
Language 
Art icula t ion 
Language 
Art icula t ion 
Language 
Art icula t ion 
-- 0.18 -- 0.49 -- 0.24 -- 0.46 
-- 0.05 0.23 0.19 0.49 
--0.38 --0.17 0.28 0.04 
0.43 0.51 0.69 0.75 
--0.51 --0.18 0.36 0.42 
0.57 0.55 1.25 1.24 
- - 0 . 4 9 0 0 . 2 0 0.12 
0.50 0.58 0.91 1.01 
--0.68 --0.43 --0.12 --0.28 
0.62 0.59 0.69 0.64 
--0.40 --0.05 0.14 0.02 
1.02 0.42 0.79 0.77 
Mean Language --0.44 --0.16 0.10 --0.02 
Art icula t ion 0.51 0.48 0.75 0.82 
The data for the LI subjects in Table 3 show that, except at the third 
grade, reading performance is notably poorer than in all other areas. Language 
was considerably stronger than reading, though it was the next weakest area 
for this group, while work study and mathematics are the areas of relative 
strength. When we view the pattern of performance across composite areas 
for the articulation group, we see that there is less variability in this group 
over the composite measures. 
The ITBS mean composite scores converted to standard scores in Table 3 
are interpreted with regard to the performance of these two groups of children 
in comparison to the test norms. As stated earlier, the children of this study 
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HALL, TOMBLIN: Follow-Up Study 237 
represent biased sampl ing coming from advan taged homes and have grea ter 
o p p o r t u n i t y for educa t iona l success t han a r a n d o m sample of chi ldren . W i t h 
this caveat in mind , it is possible to look at academic pe r fo rmance to see how 
these pa r t i cu la r ch i ld ren pe r fo rmed in r e l a t ion to the norm. We can see f rom 
the s t andard scores in T a b l e 3 tha t the LI g roup is f unc t i on i ng close to the 
mean in all areas across grades except in reading, where they fall approxi- 
mate ly one-half a s t andard dev ia t ion below the no r m mean. T h e AI group, in 
contrast , typical ly is abou t one-half to three-fourths of a s t andard dev ia t ion 
above the no rm even in reading. T h e consistent ly h igh pe r fo rmance of the AI 
group fu r the r confirms our bel ief tha t the ch i ld ren in this study represent a 
biased sampl ing of ch i ld ren since o ther data on the academic pe r fo rmance of 
ch i ld ren wi th a r t i cu l a t ion problems indica te tha t they e i ther do no t differ 
f rom n o n i m p a i r e d ch i ld ren or tha t they per fo rm more poor ly (Winitz, 1969). 
TABLE 4. Mean grade equivalent scores and difference scores (DifferencesD) in pooled standard 
deviation units for two composite and two subtest areas and total composite scores of the 
Iowa Tests of Educational Development for language-disordered (Language) and articulation- 
disordered (Articulation) children. 
Composite or Su btest Measures 
Correctness of Quantitative Total 
Grade Group Number Background Reading Expression Score 
Language 11 10.73 10.91 11.18 10.61 10.09 
9 Articulation 16 19.66" 15.75" 16.68" 18.09" 19.00" 
Difference 
scoresD - 2.05 1.19 0.75 1.56 1.85 
Language 11 12.54 12.54 12.72 12.93 12.36 
I0 Articulation 15 20.29* 18.27" 20.53* 19.85" 21.47" 
Difference 
scoresD - 1.51 1.21 1.34 1.38 1.59 
Language 11 14.23 13.45 16.81 15.45 15.42 
11 Articulation 15 20.29* 18.27" 20.53* 19.85" 21.47" 
Difference 
scoresn -- 1.65 1.01 0.88 1.08 0.86 
Language 10 15.35 17.33 17.30 16.03 16.20 
12 Articulation 14 24.14" 20.29 23.50* 23.00* 22.79* 
Difference 
scoresD -- 1.24 0.46 0.88 0.98 0.76 
*Significant difference (p (0.05) between groups. 
Iowa Tests of Educat ional Deve lopmen t Data. T a b l e 4 presents the da ta 
ob t a ined f rom the Iowa Tests of Educa t iona l Deve lopment . T h e da ta are 
based on scale scores wi th a mean of 15 and a s t andard dev ia t ion of 5. Thus , 
average pe r fo rmance of each grade level wou ld be 15. T h e da ta are of the 
same form as those repor ted in T a b l e 2 for the ITBS. I nd i v i dua l t-tests, tes t ing 
differences be tween total scores at each grade level, y ie lded significant dif- 
ferences (pwas that 50/% of the LI 
group were thought, by their parents, to continue to exhibit some form of 
communication problem. This compares to only one of the AI group, who 
was evaluated by his parents as exhibiting a continuing communication prob- 
lem. This difference cannot be explained by a difference in number of children 
given remediation, since more of the LI group received remediation than did 
the AI group. Possibly this is caused by the kind of remediation given, in that 
most of the reported services given during that time were for articulation dis- 
orders, and thus the language deficits were not treated. 
The educational data from the Iowa Tests and the parents' report of the 
client's highest level of educational achievement consistently point to a lower 
level of academic achievement in the LI subjects than tile AI subjects. This 
reduction in educational performance associated with language disorder is 
consistent with past observations (Johnson and Myklebust, 1967; Weiner, 
1974). 
It is important to note that we are distinguishing between reduced or limited 
academic achievement and abnormal or deficient academic achievement. The 
data from this study lead us to believe that the LI children did not reach the 
level of academic achievement we would expect based on tile performance of 
the AI subjects. However, we cannot claim that this level of achievement for 
the LI group is abnormal or deficient in a general sense because individuals' 
performances correlated with the test norms. 
The pattern of performance on the Iowa Tests for the LI children showed 
a definite and persistent limitation in achievement in the area of reading ac- 
companied by equally persistent but less profound restriction in the other 
academic areas. The limitation in reading is not surprising and could be 
predicted and explained from the knowledge we have of the relationship be- 
tween reading and auditory language (Rees, 1974; Perfetti and Goldman, 
1976). 
The reduced achievement of the LI children in tile areas other than reading 
may be explained in at least two ways. First, we might explain this restriction 
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HALL, TOMBLIN: Follow-Up Study 239 
in achievement in terms of the language problem itself. All of the subjects 
were taught by the use of language in either spoken or written form. An im- 
pairment in both of these forms of communication causes a decrement in 
learning. Holding this position, these children have the basic capability to 
learn. If a successful mode of communication were developed, they would 
learn normally. 
The second explanation assumes that the child with a language impairment 
has deficits of cognition extending beyond language and that the learning 
problem is not simply a result of communication limitations in the educational 
process. Inhelder (1976) expressed this view and used data from a few aphasic 
children to support this position. She reported that the cognitive performance 
of the aphasic child appears normal in those areas that permit mental opera- 
tions that can be accomplished without symbolic representation; but those 
thought systems that do require symbolic representation, even if it is non- 
linguistic, are impaired. As a result, Inhelder concluded that the aphasic child 
suffered from a specific deficit of representational thought. The notion that 
such a specific cognitive deficit may underlie the language problems of chil- 
dren such as those in this study predicts that these children would experience 
difficulties in areas that require symbolic analysis, such as mathematics. This 
position would predict that even if a successful mode of communication could 
be established, the child with a language problem would still not have the 
ability to learn in certain areas of study. The limitations in academic per- 
formance in all areas of the Iowa tests might at least partially be explained 
by this notion, and may be more fully explained in combination with the 
explanation based on communication deficits given above. 
At this point our data cannot clarify the relationship between language 
deficits and academic performance. The fact that such a reduction is present 
indicates a need to explore the relationship between specific language skills 
and specific educational tasks. Knowledge of these relationships would then 
permit the development of a definition of language disorder based on the 
functional criterion of educational performance. 
There are numerous clinical implications from the findings of these 36 sub- 
jects as they progressed through the years of formal education and prepared 
themselves to enter the work force. In the past 10 years speech-language clini- 
cians have intensified their efforts in the area of language disorders, and these 
services are becoming increasingly available to children with language deficits. 
It is apparent from this study that there is a need for educational techniques 
to teach academic skills and information to children with language disabilities. 
Therefore, coordination between the educational-specialist and the speech- 
language clinician is important. 
Overall, this study shows that there is a continuing limitation in educational 
achievement associated with the presence of a language impairment, with this 
limitation extending into adulthood. As a result, the concern of the speech- 
language pathologist about the impact of language deficits on educational 
achievement is warranted. 
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240 JOURNAL OF SPEECH AND HEARING DISORDERS XLIII 227-241 May 1978 
A C K N O W L E D G M E N T 
The authors acknowledge the assistance of the following persons in the compiling of in- 
formation and data reported in this study: Heather Carmichael, Mary Jo Fitzgerald, Andrea 
Gullickson, Paul Ingram, Cynthia Johnson, Carol Jorgenson, Cheryl Levis, Martha Marvin, 
Lois Pals, Jacqueline Petersen, Antonia Rios, Lisa Schenkein, Julia Unruh, and Barbara Wal- 
ter. Peggy Stover and Patricia McMaster are also acknowledged for the secretarial work this 
study involved. Order of authorship for this article was determined by flip of a coin. Re- 
quests for reprints should be directed to Penelope K. Hall, Department of Speech Pathology 
and Audiology, University of Iowa, Iowa City, Iowa 52242. 
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HALL, TOMBLIN: Follow-Up Study 241 
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Received January 25, 1977. 
Accepted August 9, 1977. 
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