The past, present,

and future

David

Clinical

linguistics

of linguistics
language
and

handicaps

are diagnosed

'pathological',

detailed

intervention

linguistic

pathology

has come to be carried

notably,

in educational,

though

therapy

'clinical'

and

characterise
approach
gain

'remedial'

both.

of many

insights

referred

a new way

in other

domains,

interpretation
language
devise

explicitly

principled

for explaining
and thus

comes

when

patient's
days

clinical

prgress

insight

in a mass
respond

confidence

and clinical

teaching.

which

More

strategies.

problems

In my
of a patient's

can provide

a basis

with patients,

specifically,
Clinical

the efficacy

more

the aim

confidence

of their

that the reason

significantly,

for a

in these

it to any who are sceptical.

about

enables

them to see a ~attern

patients'

The aim is to

in working

insight.

training

predictions

to solve

linguistics.

to verify

and (perhaps

comes when therapists'

of dat~, and to make

to these

but first and foremost

I see the remediation

professionalism.

to be able to prove

is not principally

to use linguistics

and the failures

be

but it is not the

- to be able to say, in effect,

is due to t~em,
cuts)

theory,

of intervention,

are in a position

strategies

of economic

Clinical

a more conscious

therapists

intervention

methods

data in order to

linguistics

goal of clinical

with the

This too might

linguistics',

and language

therefore,

both the successes

develop

is to develop

therapy

between

and methodology

however,

language

theory.

in linguistic

- an attempt

as the primary

a distinction

study clinical

For me, clinical

skills

is

in speech

for the same philosophy

of 'clinical

problems

in

linguistics'.

does need to be drawn,

who

subject,

course

of

to those

is a word which

one training

is no need to make

such as speech

of this

talks

refers

or neurological

linguistics

the concept

in despair,

neurolinguists,

of applied

where

all, one usually

'remedial'

kind

also - most

who regularly,

A distinction

in to solving

a similar

'therapists'

linguistics,

I use in my work.

of

rather than

there

into linguistic

after

first

of 'teachers'

'remedial

to under the heading

orientation

branch

purposes,

which

In recent years,

In schools,

has come to

and the context

contexts,

and at least

is known by the label

'clinical'

the settings

clinic.

As a consequence,

used these days,

For present

because

but

where

such as 'remedial'

and psychological

'patients',

I do know of one teacher

increasingly

'clinical',

terms,

settings

social,

as 'patients'!

Other

and findings

situations

out in non-medical

is less appropriate.

rather than

his care

and treated.

methods,

of those

study were medical,

of study

'pupils'

to the study

of the subject

was the speech

of 'clinical'

of the theories,

are used alongside

be the usual designation

attracted

phonetics)

linguistics

Crystal

is the application

(including

of clinical

progress

as they

The
under

specific

eight

contributions

headings.

First,

there

in the use of the traditional

the

first

at traditional

wanting.
with

inspired

labels

disparate

children,

the picture

the tradition
the field

with
areas

a clear

articulation

reason

language

problems,

told me of receiving
buck'

[=

transfer

up at the speech

say,

'Mr X - no detectable

there

diagnose

a patient's

to devise

description
linguistic

with

condition,

what

of the nature
area

of clinical

of the patient's

is to appreciate
which must

handicap

that,

is, essentially,

kind of independent

existence

or
have

'pass the

in one hospital

is one to do?

For after

to it: diagnosis

process.

The speech
and these

in its own terms.

linguistic

involves

which

And even

enquiry:

behaviour,

regularly
which

between

both patient

an interactive

and where
in cases where
all, to

is the
therapist
come

from a

This

therefore

the systematic

them.

Here,

handicap,

delay,

own

the important

the linguistic

and therapist

phenomenon.

- as if language

still

must

of the therapist's

in the field of language

be made

and

therapists

is one to do?

and of the interaction

in such

from the ENT surgeon

to work with,

linguistic

speech

we

do not present

is unknown

abnormal,

of the problem

problems

treat'!

is not a solution

procedures

to

in our subject,

is demonstrably

what

to

in speech

stammering,

colleagues

notes

- please

language

point

of the condition

patients

of

not come from

we deal with

Several

of

is extended

cases, especially

from their medical

clinic

range

of the linguistic

voice disorders,

voice

are found

An alternative

of the early work

help us.

look

dissatisfaction

But this will

In so many

cannot

is always

interpretations

and unreal.

to most

aetiology

condition,

problem

behaviour,

description

some

whose

linguistic

to the second

Language

symptoms.

This

- the use of such medically

as a starting

not the end of the therapeutic

consideration

point

answer

pathology

they

is widespread

that 60% of the patients

notes

with a patient

a clear medical

leads

so much

is essential

therapist's

there ~

needs

fathered

model

is no clear medical

beginning,

needed.

the responsibility]:

turn

Faced

is urgently

development,

case

respects

and when the term

complex

of confusion

One must

are over 100 clinical

for example;

the medical

and the medical

pathology.

to apply to a wide

still more

model

set of medical

as delayed

There

only a limited

for the simple

unclear,

which

The medical

but it can provide

'dyspraxia'

context,

of 'labelling'

there

can be summarised

of areas

to a subject.

of the subject

and

becomes

of medicine,

pathology.

pathology,

conditions.

in the adult

of speech

and see in what

nomenclature

as 'aphasia'

clinical

'aphasia',

face,

models,

can make

is the clarification

a new approach

In the case of speech

the traditional

linguistics

metalanguage

step in developing

critically

clinical

equally.

It does

not have

or an articulation

disorder,

resided

'in' the patient,

might

watch

other

forms of handicap

last

someone

with

person you passed

handicap

does not show.

voice,

interaction,

handicap,

fluency,

you will

Then,

never

significance.

we talk

crucially

kind of linguistic

affects

them,

inadequacies

for plosives,

plosive-deficient
emerge,

our initial

or simply
they

referred

focussing

a product

in many

parts of Europe,

terms.

But such projects

have no future,

conflicting

symptoms

our patients

types

foundation
speech

present

can
in

present.

projects

are doomed

a promising

{uture

are controversial.
to obtain

is

speech

pathology

descriptive

research

Abstract

will we be able to see the

satisfactory

to failure,
simplistic

without

descriptions

for

a
of

and premature.
linguistic

past history,

for this

labels

and dictionaries

in my second aim,

Th~ reason

satisfa~tory

there

have been established

try to proceed

to be considered

which

I initially

Only once we have provided

at more

which

to present,

faced with the vast range of

and tests,

arrive

for we are

nomenclature

the basic

Thi s is an area whi ch has a very short

apparatus

patient;

picture

from past,

and standardise

are of no help,

and thus

research

will continue

activities

appropriate

Terminology

is, however,

descri pt ion.

we

the

the patient's,

has not been done.

using pr6files

patients,

of descriptive

pathology

There

which

pictures,

of disorder.

out

for pronouns,

of my paper,

projects

because

if you will)

of terms

between

alongside

The traditional

Terminology

of the meaning

similarities

determines

If we test

as we move

to try to rationalise

research,

descriptive

turns

that the way in which

of our past, and one about

definitions

clear

a language

The kind of questions

the title

points,

work.

a great deal of concern.

(symptomatological

Without

we say we have a

our language,

I can address

linguistic

to is certainly

presently

in

study.

here at one of the crucial

in clinical

from

apparent.

with them,

to us.

Apart

has a handicap

It is easy to see how a distorted

It is at this point that

to future

present

the

language

talk to patients

converse

whether

we say we have a pronoun-deficient

into account

descriptive

become

diagnosis.

most

is one of production,

even be argued

their

aids,

in order to identify

and find them missing,

patient.

unless we take

the problem

Thus,

unlike

or not.

someone

it will

It might

let us say, and find them missing,

if we test

know that

of the way therapists

to be of particular

put to them, when we test

handicap

communication

whether

know.

is quite

as one

is no way of knowing

has a language

or whatever,

the characteristics

to patients

There

The only way you

from afar,

handicap

who use instrumental

is - to talk to them.

comprehension,
this

patients

be observed

Language

respect.

in the street

of those

area

one leg.

in this

the case

this

only

and could

and where

is the lack of
in the first

place.

It is easy

enough

language;
aspects

much

to say that we should

less easy to decide

of the language

phonology

(segmental

and other aspects

in language

use.

description

patient,

which

descriptions
been many

which have

various

patient's
various

fragments

project

in Britain

described
then

published,

together.
in which,

disability

manner,

'elementary',
patient

when

incidentally:

language

in clinical

undoubtedly

twenty

important

enable
loved

ratios

those

is future,

few clinical

which exist

the descriptions

involved

in this

clinically-oriented
proved

linguists

to be carried

linguistic

to as 'linguistic

and is known
Screening
profile;
GRARSP,

field,

by the acronym

models

Procedure

- a misnomer,

but we wished
which

to avoid

would sound like

(=

arrive

with
at a set

be possible
between

the word

basic

features

of word types

of

and tokens

say in half an hour,

do ~

research

say?

There

is that

are

hunting

place.

twenty

impossible,
to use.

the apparatus
I would

years

there

The main

profile

for only

grammar

overtones

to

have

ago, when

because

Assessment

'grasp' in English.

speech

1 first

were no

task thus

was the various

The earliest
the Language

for the past

aware

time devising

out in the first

the unfortunate

disability

it will

and linguistically

actually,

We shall

to be established.)

and the result

profiles'.

is being

of view.

(1 mean

does a patient

available

of a

Council

the relationship

the frequency

but it proved

LARSP

least,

of many

have yet

along

Research

hopefully,

language.

have had to spend their

to be one of model devising,

we refer

and,

and not past

to get on with the task of syndrome

became

point

How many words

here, which

have

of aspects

of patients

on grammatical

ignorant

how many words

conversation?

reason why this

pathologists

we are still

Just

in general

years

in patients'

There

for example,

a Medical

data concerning

- such as, for example,

sessions.

engaged

The

and vocabulary

field.

to try to bring these

a range

At the very

quantitative

generalise

clinical

descriptions

directing

disability,

syndromes.

some elementary

grammar,

detailed

from a linguistic

and semantic

involved

is an unfortunate

- in my own work,

some of the findings

factors

had a comprehensive

- and this

for the first time,

of

and syntax,

in the medical

1 am currently

that ~

I can immediately

but we are only now in a position

of linguistically-definable

sounds,

of course

a patient's

the many aspects

with the meticulous

we have published

be able to synthesise

to provide

include

morphology

has yet

published

unfavourably

in a comprehensive

phonological

must

and the pragmatic

long been available

colleagues,

language;

symptoms

describe

it, to ensure

I put it like this,

to my knowledge,

contrasts

fragments

of semantics,

when

of his language

situation,

with

Indeed,

- which

as non-segmental),

vocabulary,

and say that ~

how to go about

are considered

as well

systematically

devices

appeared

in 1976,

Remediation
is handled

of having

which

and
by this

the acronym

We did not want to have our

our patients
phonology,
mainly

'grarsped'!)

A little

known as PROPH

intonation,

known

later, we produced

Profile

(=

(=

as PROP

in Phonology),
Prosody

(=

Profile

in Semantics

- Lexical),

as PRISM-G

(= Profile

in Semantics

- Grammatical),

are being

used

in our current

methodological
not without

decisions

controversy

research.

come to be devised.

weaknesses

of a clinical

indeed,

this

procedures
there

have been published,

development,

bogged

procedure

when you

is how I began myself

is considerable

watched,

It is always

to avoid theoretical

for it is easy
down

conferences

stopped

talking

of sampling

and statistical

issues.
about

have something

This

analysis.

apparent

were

as other

to compare
several

and

it with -

new

and segmental

is a necessary

phonology,

and desirable

but it has to be carefully

It would

be a shame

and become

if clinical

and began talking

There

and

profiles

to lose its sense of direction,

patients

known

easier to see the strengths

complacency,

for a subject

in methodological

these

increasingly

in grammar

fuel for argument.

semantics,

theoretical

- and as in recent years

especially

known

and these are the ones which

in devising

becomes

phonology,

semantics,

and grammatical

which we had to make

procedures

lexical

But the innumerable

- a point which

for segmental

non-segmental

Profile),

as PRISM-L

profiles

only

about

needs to be a balance

problems

in all

things.
Similar
clinical

linguistics,

The third
extent
aim,

issues arise

as already

behaviours,

of approximation
with

In the case

patients

child

language

research

undertaken

In May,

for example,

English

language

the relevant

into both these

of the Journal

are available

comparison

And the

years

areas

for the adult

is the descriptive

has seen an enormous

- at least,

language.

research

for English,

in

Grammar

of

to English.

grammar

of the

of the English

And one has only to pick up an

to see the way that field

to make

grammar

amount

in relation

of the largest

A Comprehensive

phonology,

fifth aim

too, we have an issue of past,

at least

of adult and child

diagnosis.

are

Language

many

linguistic

patients

of Child

possible,

patient

The fourth

In the case of adults,

and his colleagues.

It is thus
areas

systematically.

the

on scales

we see the publication

Quirk

descriptions.

position

Here,

The past twenty

aims of

their

norms which

ever to appear,

by-Randolph

language

by demonstrating

norms.

acquisition.

and fifth

in order to demonstrate

of differential

behaviours,

the descriptive

and future.

Language,

of the descriptions,

to linguistic

fourth,

on from the need for systematic

is the need to classify

of these

of children,

to the third,

are using their

mentioned,

present,

issue

follow

as part of the process

is the assessment

normal

which

aim is the analysis

to which

compared

in relation

systematic

and semantics

has developed.

comparisons
-

for

and

in view of the current

assessments
USA.

This

saying,

in that area are also

interest

of research
Without

clinical

of systematic

is no replacement

period

about

consonants,

phonological
(certain

define
their

quantitative

language
a great

deal

The
stated.

impression

for Spanish

sixth,

Sixthly,

we have,

Language,

linguistics

proceeds.

And eighthly,

foundation

of activity

assessment,

which

an adequate

description,

their

work.

presupposes

in reverse

analysis,

therapists

This is not of course

of the experienced

therapist,

cannot

the

profile

work

is

items on Spanish

this

is that

is a

linguistic

hypotheses,

presupposes

to deny the value

but if this approach

used in the

At last, then,
This

to reach

it,

This

presupposes

description.

the objective

Without

basis

of the intuitive

on occasion

we

is the world

presupposes.

Remediation

guarantee

as teaching

it has taken
work

of

behaviour.

strategies

or classroom.

clinical

can be briefly

the formulation

remedial

order.

which

role is to

linguistics

note how long

which

in

acquisitional

are involved.

of clinic

and the complex

aims

the

variables

But please

words

but my impression

abnormal

of these

we need to evaluate

pathology.

of

to supplement

on the basis of an assessment,

the outcome

can be seen if I put these

their

is correct,

aims of clinical

speech

of

in the future.

we need to eveluate

of daily

a feature

the way in which

published

If this impression

'real' world

in a

information

Most tests

of language,

Seventhly,

with the

after

look at morphology

But without

of the patient's

are in contact

elicit

tests

syntax.

testing.

of Child

as linguistic

A test,

are just as much

behaviour,

for the remediation

insofar

but a test

to be administered

are not tests:

hypotheses

intervention,

use of

aim to be far more comprehensive,

from time to time

and eighth

place.

a start,

language.

and ignore

and structures

clinical

seventh,

They

at through

in the Journal

The conventional

grammar

of linguistic

remains to be done.

area

items,

by contrast,

We have

acquisition

priority

lexical

to grade the sounds

foundation.

Most

amount

I do not know how one makes

for example,

and ignore

topics.

scores arrived

information

tests,

I keep

is the limited

is of course

- but vowels

in particular)

in the

the development

has so far taken

designed

as are consonants.

of linguistic

a qualitative

without

vowels

especially

hindering

of a patient's

articulation

Profiles,

norms,

we need.

instrument,

look at individual

each other.

provide

Most

and ignore

handicap

coverage

which

which

and vocabulary

selective

word-endings,

vocabulary

acquisition

clinical

but what of the future?

for Spanish

of acquisitional

grammar,

of time.

to be made,

problem

procedures

for a full assessment

is an extremely

short

The biggest

assessments

of articulation,

in pragmatics,

and productive;

language

account

interest

now beginning

linguistic

into Spanish

a detailed

the kind

all,

is ongoing,

lat least for English'

of comparable

tests

linguistic

of

approach

does not work,

or

if therapists
failures,

want to be able to explain

the need for systematic

a foundation

does the future

systematic

study of those

promoting

language

that

procedures

occasion,
which

interfere

the therapist

about

development.
'work'.

which

their

Therapist:

in some way

Others
(e.g.

requests

and

paramount,

In language

as

Clinical

many

subject

Patient:

of these

do anything
the actual

rules and

'A car'.

for
(e.g.

Therapist:

on what the patient

There

are many
possible

ways

ways of

of

questions,

prompts,

and so

have been studied

interaction,

of 'therapese',

has said

possible

specific

strategies

of

(or

out an activity

to pay attention,

of parent-child

is room for a corresponding

cannot

is to study

questions,

instructions

variables

Some therapists,

and also many

(open-ended

And why, on

interest

the linguistic

in

to learn

are so many

linguistics

follow.

it').

are efficacious

work?

intrinsic

try to build

has said,

to speak

in the context

There

who has carried

isn't

is the

- such as the personality

and the

see in the picture?'

acquisition,

believe

task

long for therapists

to determine

a patient

commands,

important

it can do, and that

'It's a big car,

to imitate,

some years,

used.

do not. Others

the patient

of cause

and therapist

to what the patient

stimulating

successes
becomes

is: Why do they

rapport,

interaction,

'What can you

'Good boy!').

reacting

being

praise

therapists

or not at all?

statement

both patient

The most

It does not take

but one thing

regularly

which

so well,

and patient,

of a clinical

example,

and analysis

area?

The question

with a simple

such matters,

tendencies

in this

strategies

of the materials

progress

on).

hold

do they not work

boredom)

description

of their

of enquiry.

What

some

the basis

or 'motherese'.

for
There

and I hope to see it develop

over the next few years.

Which
of language
patient

leads to my final point about the future.

handicap

behaviour,

have

as outlined

disordered

language

handicap.

To describe

a patient's

in terms

handicap

as it progresses.

difference

of which

The language
between

above.

it will

is there,

handicap

cannot

be captured
a diachronic

over time

language
become

on tape

it an an anatomical

does not have to be kepi

to change

synchronic

But a synchronic

specimen

in this way.
phenomenon

in the normal

way.

day gives

The

A language
- the result

of

us only a

the nature

handicap

is that

of language

is

of a failure

The fact of change

The only

laboratory

reality

of the

of the

but frozen.

in a medical

in formaldehyde.

of a sample

a snapshot

or on the page,

of

of a language

to measure

as it were,

studies

descriptions

account

on a certain

possible

We have taken,

language

quintessentially

us with

is only a part of the characterisation

baseline

problem.

begun to provide

So far, linguistic

of language

is central

to our

8
understanding
monitoring

it, and building

questions
remain

of the condition,

about diagnosis,

elusive.

longitudinal
patient's
sample,

language,

give us the

constructing
information

has the patient

'holding

his own',

the catching

a 'learning

child,

made

has been working

of their

impressions

are not enough,

confidence
already

patients'

with which

been made

is in its infancy.

relatives

urgently

such as the time

this
grope

future

fairly

to provide

of clinical
a precise,

words.

linguistic

confident,

when we have done this,

between

(i.e. he is

comparable

made

up their

one.

research
professional

intuitive

strides

get better?'

have

prognosis

the one

all our patients'

parents

and

All other

description

and

We need to be able to answer

and at present,
I therefore

which

in the

Great

to answer

linguistic

has

is to be placed on

but the field of linguistic

which

but intuitive

to medicine

and prognoses.

to do clinical
this

progress

areas,

of course;

pathology

be in a position

and not before,

of 6 months

will write

'Will the patient

and squarely,

for some sympathetic

aims

diagnosis;

beside

In a

or only in certain

of speech

its diagnoses

it takes

of therapy.

And if the latter,

in case notes,

point of view,

pale in significance

question,

up somewhat?

and to become

want to know,

on each

Only this will

Or has he actually

All therapists

One day, we must

of the

analysis

in that time

behind)?

of language,

progress

in linguistic

from a linguistic

analysis,

samples

Or has he made only 3 months

caught

on?

it makes

question,

issues,

up)?

if the field

footing,

is a period

progress

will

to produce

for the patient.

if there

further

- in other words,

scientific

essential

by

to our

of teaching,

about the efficacy

six months

but not catching

impressions

a solid,

answers

- to take regular

curvel

for instance,

up been in all areas

the therapist

absolutely

handicaps

(i.e. he is falling

progress

and the efficacy

we need to know

samples,

time

of handicap,

and carry out the same kind of linguistic

delayed

months

remediation,

of language

language

in that

we take this fact into account,

it into our model

It is, accordingly,

accounts

thus

and until

we can only

find I cannot

any more
answer

can we relax.

flounder,

summarise

succinctly

the

than this:

to that question.

as we

it is

Oney