When is "Watch and See" Warranted? A Response to Paul's 1996 Article, "Clinical Implications of the Natural History of Slow Expressive Language Development".

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American Journal of Speech-Language Pathology





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We commend Paul for undertaking an investigation that concernscritical clinical and theoretical issues. This type of longitudinaldevelopmental research is exactly what is needed to advancethe scientific basis of our profession. We also respect Paul'sattempt to construct a firm bridge between her findings andtheir clinical implications. The necessary and sufficient datathat completely solve a clinical problem are rarely available.Because clinicians do not have the luxury of waiting until thebest data imaginable are collected and analyzed before acting,it is helpful for researchers to generalize their results tothe extent possible. However, because of its potential clinical,economic, and educational implications, we believe that a broadsocial policy like Paul's "watch and see" recommendation shouldbe based on unambiguous evidence.

We have suggested that a numberof the children in Paul's cohort may have been within the normalrange in language development at the beginning of the study.Without individual data, it is impossible for us to know whetheror not this was the case. To the extent that our suspicionshold true, Paul's study tells us that a number of children whofunction at the low end of the normal range of language developmentbetween 20 and 34 months stay within the normal range throughoutthe preschool and early school-age years.

Paul's suggestionof "watch and see" seems reasonable enough for the 74% of thechildren who tested within the normal range by kindergartenand first grade, but it may not have been sufficient for the26% who did not. We believe children like those in this lattergroup would probably benefit from preschool language interventionand that very valuable language learning time could be lostif Paul's general "watch and see" policy were implemented.

Itis possible that children with good outcomes and children withlanguage delays that were significant and persistent had differentprofiles with respect to expressive vocabulary, receptive vocabulary,speech, and communicative intentions at the onset of the study.If so, one broad social policy may not be sufficient. We haveasked Paul to provide additional data about the nature of thelanguage difficulties exhibited by the children at the outsetof her study, the predictors of continued language delay, andthe results of language intervention efforts. It is our hopethat Paul can provide the kinds of additional data and analyseswe have requested in this discussion, and that this data canserve as the basis for refinements in definitions of early languagedelay, decisions about providing clinical services to very youngchildren, and methods for analyzing intervention efficacy.


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