The Processing Period 1945-1965
The end of the second world war represents the beginning of a change in approaches of mainstream speech pathology in America, from those that emphasized the atomistic and peripheral aspects of speech reception and production to those that allowed for more wholistic and conceptual representations of speech and language processing. During this period clinicians began to acknowledge that there was something else going on in speech besides perception and motor production of sounds, something variably dubbed symbol formation (Eisenson, 1968a) inner language (e.g., Goldstein, 1948; Myklebust, 1952), mediation (Osgood, 1957) and psycholinguistic processing (Osgood, 1957).
This move away from peripheralism toward mentalism derived from several sources, not the least being the increased incidence of aphasia as a result of war injuries in the second world war (Backus, 1945; Eisenson, 1968b; Wepman, 1947, 1951). As a result of head injuries of soldiers returning from Europe during World War II, aphasiologists in America developed a European view of psychological effects of war injuries. This included the assumption that aphasia is a language disorder disorder rather than a speech problem (Head, 1926). A second source for this mentalism move was also a fallout of the second world war, that is the immigration of Jewish European scholars and clinicians. These individuals were accustomed to looking behind the surface of speech problems problems for ideas and inner processes .
Among the most influential of these Jewish-European immigrants was Kurt Goldstein. Goldstein, a neuropsychiatrist and student of Wernicke's, is known for his studies of aphasic patients. He began those studies in Germany with his studies of brain-injured veterans of World War I, and continued in the United States with his studies patients he met in his various work settings. His many years of research and experiences with aphasics culminated in his highly influential book in 1948 entitled Language and Language Disturbances (Goldstein, 1948).
In the early pages of his book, Goldstein explicated his version of "organismic theory" as it applies to aphasia. Goldstein's organismic view holds that one must look at language symptoms in their context in order to decide what to do clinically. Further, that the symptoms are in part determined by our assessment procedures. Even when people perform adequately they may not do so on another occasion in another context. The organismic view has a kindred theory in gestalt psychology, in that they both emphasize the importance of context and they both criticize the atomistic approach of isolating parts from the whole.
Of particular relevance to Americans reading Goldstein were his ideas of symbol formation, his concept of concrete and abstract attitudes to account for literalness in aphasia, and his notion of inner speech, a level of language located in processing somewhere between perceived and motor speech. Indeed, Goldstein felt the need to add central aphasia to the established categories of sensory and motor aphasia to account for the breakdowns at the level of inner speech. These ideas allowed Americans to begin to think about higher order gestalt processing as a system separable from analytic units of sensory stimuli and motor responses.
Goldstein's theories and studies in aphasia had their counterpart in studies of normal language in children done by Heinz Werner. Like Goldstein, Werner immigrated to America from Europe after having assimilated the theories of psychology in Germany--theories that contained mentalism, gestalt processing, and attendance to the whole organism. While Goldstein combined these into an organismic view of aphasia, Werner related them to an organismic view of language acquisition and cognitive development. His first expression of this organismic view preceded Goldstein's 1948 landmark by eight years. The text he wrote was called Comparative Psychology of Mental Development (Werner, 1940). Werner's later and better known text for those interested in language was coauthored with Bernard Kaplan, and appeared in 1963 under the title: Symbol Formation: An Organismic Developmental Approach to Language and the Expression of Thought (Werner & Kaplan, 1963).
For a year Werner worked at the Wayne County School as chief psychologist and there he worked with Alfred Strauss who was the primary translator of organismic and gestalt theory to educators of handicapped children. In 1947, Strauss co?authored a book with Laura Lehtinen in which he and Lehtinen used organismic and gestalt theory as a grounding for their educational methods for working children they called "brain injured" (Strauss & Lehtinen, 1947). The book was called Psychopathology and Education of the Brain Injured Child.Both Strauss and Lehtinen were affiliated with the Cove School for Brain Injured Children in Racine Wisconsin (Strauss founded the school) and it was there that they designed their methods to educate children who exhibited symptoms of that later came to be called "Strauss syndrome."
Strauss's ideas differed from Werner's in that Strauss favored the perceptual rather than the language or cognition side of processing theories. Lehtinen's training program includes visual figure ground differentiation, learning to recognize incomplete figures, and eliminating distractibility by stripping the environment of non-relevant stimuli. The Strauss and Lehtinen book was historically pertinent to speech-language pathologists not for the methods that it developed for language training, but because it marked the beginning of an era which regarded language handicapped children as brain-damaged.
Another influential Jew who fled Europe in the Second World War was Emil Froeschels. Froeschels influenced practice in America even before his arrival in 1938, since experts in America such as Sara Stinchfield-Hawk and Edward Wheeler Scripture visited Froeschels' speech clinic in Vienna to develop expertise in treating children and adults with speech defects. Froeschels, trained as an otologist, was a prolific writer, both in German and English, producing in his lifetime 23 books and 317 articles having to do with clinical practices in speech, hearing, and language. Froeschels' therapy approaches were varied, including psychoanalytic approaches for treating neuroses underlying speech problems, sentence repetition for those with syntax problems, phonetic placement approaches for those with speech difficulties and aphasia, and movement training approaches for those with voice and rhythm problems. Froeschels likened childhood language disorders to adult aphasias and created therapies such as phonetic placement and grammar drills for both (Froeschels, 1918).
Helmur Myklebust was probably the person most responsible for offering elaborated on previous models of internal processing and using the model as a guide for clinical interventions. His 1954 book, Auditory Disorders in Children (Myklebust, 1954) was, as he called it, "a manual for differential diagnosis," differentiating between the clinical syndromes of peripheral deafness, psychic deafness (emotional disturbance), mental deficiency, and childhood aphasia. Myklebust regarded auditory processing as of primary importance rather than as secondary to visual perception as did Strauss and his followers. Myklebust's view of auditory processing included a level of inner language, and his procedures required that we evaluate the child's inner language competence. Following Goldstein, Myklebust argued for three types of language problems: receptive, expressive and inner.
Myklebust published a number of articles and books over the next ten years or so, many with his colleague at Northwestern University, Doris Johnson.Their therapy for auditory disorders was to teach sound awareness by matching environmental sounds with their origins (e.g., matching noises to toy noisemakers); and to teach sound localization by indicating the directional source of the sound while blindfolded (Johnson & Myklebust, 1967).
Inner language training, which Myklebust argued should precede receptive and expressive language training, involved "assisting the child to structure his experiences so that they became meaningful and so that he can relate more effectively to his environment" (Myklebust, 1957). The means for such structuring is through play where toys are used which "represent his daily experiences" (e.g., furniture, family, dolls). The child is taught to "act out routines of his daily experiences" (Myklebust, 1957, p. 527).
For receptive language disorders, Myklebust (1954) and later Johnson and Myklebust (1967) recommended beginning with offering the child the whole word by doing such things as matching the word to its associated object. For expressive disorders such as word finding or syntax problems, they had several procedural approaches: sentence completion tasks; association tasks which required pairing familiar words (bread and butter), mirror practice for developing motor facility, and unscrambling mixed?up sentences.
In sum, Myklebust added to previous notions of auditory processing, providing a more detailed view of inner processing, separable from the atomistic and peripheral conceptualizations of our founding mothers and fathers. He also was the first American-trained speech?language pathologist to focus on language disorders of children as distinct from speech disorders, and to design techniques for remediating language problems, as such.
Later, additional processing based therapies were developed adding to both the perceptual motor approach of Strauss and Lehtinen (Cruickshank, Bontzen, Ratzebury, & Tannhauser, 1961; Frostig & Horne, 1964; Kephart, 1960) and to Myklebust's auditory perceptual processing approach (Eisenson, 1957). Some of these later developing auditory processing programs focused on sounds and sound combinations (Calvert, Ceriotti, & Geile, 1966; Monsees, 1972) or with whole words (Karlin & Strazzula, 1952). Some covered their bases by using a combination of sound and whole-word approaches (Barry, 1961). Nevertheless, they all were based on the assumption that speech and language disorders should involve work on processing.
Many contributors to the processing approaches presumed that the source of the communication problems was brain damage. Children and adults found to have with language processing disorders were diagnosed as aphasic. The earlier diagnostic category of delayed speech in children was replaced by aphasia by some, and differentiated from aphasia by others. For example, McGinnis (McGinnis, 1963) and her followers (Calvert, Ceriotti, & Geile, 1966) differentiated delayed speech from aphasia by degree of severity. Those with delayed speech were the children who progressed rapidly under the association method, never needing to be tutored in unit two or three. Wood (Wood, 1964) following Myklebust's differential diagnostic model, used "delayed speech and language development" as a general term to mean the speech and language symptoms originating in any of the following syndromes: aphasia, mental retardation, emotional disturbance, hearing loss, speech deprivation, or immaturity.
Van Riper, in his 1954 edition of Speech Correction, mentioned aphasia in passing, as an uncommon cause of delayed speech (Van Riper, 1954). In 1963, however, he added a whole chapter on aphasia in adults and expanded the section on aphasia in children (Van Riper, 1963). In this later edition, he clearly differentiated language from speech for the first time, calling delayed language and aphasia a disorder of symbolization. In his 1963 therapy recommendations for aphasic children, Van Riper departed from his analytic sound training approach and instead recommended working with gestalts: familiar materials and concrete things. The notion of concrete probably reflects Goldstein's distinction between concrete and abstract attitudes in adult aphasics. Van Riper also borrowed from Strauss and Lehtinen (1947) when they recommended removing distractions in order to "decrease or desensitize the child to outside stimulation (p. 123)."
There was very little resistance in our field at this time to assuming brain damage as a source of language disorders. There were, however, several complaints against the atomistic view of language therapy. one of the clearest statements against atomistic therapy in drill or game formats was made by Ollie Backus and Jane Beasley in their book entitled Speech Therapy with Children (Backus & Beasley, 1951).
Backus and Beasley open their text with "Speech therapy more and more is shifting away from an orientation based primarily upon devices, toward one based primarily upon therapeutic relationship." They base their rationale for the shift to more conversational therapies on gestalt psychology as expressed in the writings of Carl Rogers (1951) and Kurt Lewin (1935) and on the personality theorists Karen Horney (1939) and Harry Stack Sullivan (1947). From this theoretical conglomerate, they develop a conceptualization of what speech pathologist should do in therapy. Their prescription includes defining a goal region as the therapy direction, (Lewin, 1935) structuring the therapy session in terms of interpersonal relationships (Horney, 1939; Rogers, 1951; Sullivan, 1947); aiding the client in assuming the responsibility for change (Horney, 1945) regarding the child's behavior as one part of the interaction, and seeing the speech problem from the child's point of view (Sullivan; 1947).
The clinical procedures which Backus and Beasley derive from their borrowings of gestalt and personality theory lead to their working with children in a clinically mixed group of eight to ten. In their framework, children are viewed in terms of the ongoing interpersonal dynamics rather than in terms of their clinical diagnosis. Therapy is organized around conversationally meaningful phrases rather than beginning with practice on identifying or saying individual sounds. Backus and Beasley's conversational approach was supported by Elise Hahn (Hahn, 1960) in an article aptly named Communication in the therapy session: A point of view. Hahn argued for self-motivated conversation, where the child talks because he wants to communicate his ideas and feelings. Hahn also contended that the act of communicating is the basic unit, and that saying the "k" sound in isolation and in the context of a game is likely to be less successful because it is a "part process" rather than a natural whole. Hahn argued that therapists would do better to develop a comfortable relationship with the child and then provide the child with a model to imitate spontaneously. Thus, rather than using individual sounds, Hahn recommends beginning with a purposeful phrase. Her script of a sample lesson runs as follows:
Clinician: Where's the kitty hiding now Tom?
Child: In the tar.
Clinician: Let's try the sound that needs changing. (Therapist demonstrates showing placement, allowing the child to look and listen carefully.) Now when we use that word in our own stories, we'll know how to say it just right so that everyone can understand us (p.21).
Changes in therapy approaches during this second stage of our development not only involved changes in unit size (words rather than sounds) but also conceptual abstracts of units. Interesting, an important shift toward abstraction came from behaviorists who aimed to extend strict peripheralist models involving simple stimulus-responses chains to conceptual models involving a representational or mediation level of processing. Joseph Wepman and his colleagues from work in aphasia (Wepman, Jones, Bock, & VanPelt, 1960) and Charles Osgood from work in normal experimental psychology (Osgood, 1957) added a mental component to a behavioral model, thereby allowing a place for language processing. Osgood called his language level the "representational" level, and placed in it responses which were previously associated with stimuli. Wepman and colleagues called their language level "integrative." Wepman et al. saw aphasia as a breakdown at the integrative level, where the person can no longer associate meaning with presenting stimuli. Because both frameworks viewed language processing as building a chain of internal stimuli and responses between the external or observable stimuli and responses, the models were called mediation theories.
The Wepman and Osgood conceptualizations of language processing as involving internal associations gained significance for language clinicians in 1961 when Samuel Kirk and James McCarthy published their experimental edition of a test based on the mediation model (Kirk & McCarthy, 1961). The test makers developed their instrument at the University of Illinois where they had been attending Osgood's psycholinguistic seminar. They called it the Illinois Test of Psycholinguistic Abilities. The test contained twelve subtests designed to measure various processing components of Wepman's and ;'s model, and to measure those levels for both auditory and visual stimuli. The impact of the test and its underlying framework on our thinking and our language therapy was dramatic. Commercial programs and activities were soon developed for teaching to specific psycholinguistic processing areas that were revealed as deficient by the ITPA profile (Bush & Giles, 1969; Karnes, 1968; Minskoff, Wiseman, & Minskoff, 1972). Children were classified according to their deficit picture on the ITPA, resulting in visual as well as auditory focused training at both automatic and mediated levels of processing. These approaches emphasized language processing over language content, an emphasis which was to reassert itself later in approaches designed for older children and adults with language-learning disabilities.
At about this time, another model of clinical intervention emerged in which communication was seen as a mechanical feedback system (Fairbanks, 1950; Mysak, 1950). Borrowing from Norbert Wiener's cybernetic theory of communication (Wiener, 1961), speech pathologists subscribing to this approach saw speech as a "closed, multiple-loop system containing feed forward and feedback internal and extenral loops" (Mysak, 1966, p. 32). This model, like that of Osgood and Wepman involved internal constructs, in this case thoughts, that were part of internal loops (e.g., Mysak 1966, p. 18). Therapies involved closing external and internal loops such. For example, audioverbal loops were created through auditory closure activities in which a person is provided with an incomplete statement and asked to fill it in (Mysak, 1966, p. 56). Mysak called the approaches "self adjusting therapies" since they required that clients change their communication by incorporating feedback from their previous communications (Mysak, 1976, p.252-271).
Just as for the period between 1925 and 1945, there was a wave of research and theorizing in child development in this post war period that focused on language content of children's language development. At this time, however, mainstream speech-language pathologists were ready to listen to a more linguistic orientation. The linguistic study of language became most influential was the 1957 monograph Mildred Templin called Certain Language Skills in Children (Templin, 1957). Templin's work was done at the University of Minnesota's Institute of Child Welfare and incorporated the "McCarthy method" of analyzing children's language into sentence complexity types and parts of speech. Templin, an American trained speech pathologist, grounded her work in the methods of those in child development, an area which remained less susceptible to behaviorism in this country and more mentalistic and linguistic in its approaches to the study of children's language development (McCarthy, 1946)
Templin's research was a normative study in which she examined the language of 480 children who ranged in age from three to eight years. She looked at four aspects of what she called "language": articulation of sounds; speech sound discrimination; sentence structure, and vocabulary. For her sentence structure measures, Templin obtained 50 verbal utterances from each child and measured mean length of response, number of different words, parts of speech and sentence complexity (completeness, type of sentence, and type of subordination).
Templin's study and others of the linguistics genre did not draw conclusions about what sort of language therapy to carry out for those children who departed from her norms, but those who read her study were influenced by her linguistic orientation. Therapists to follow used Templin's developmental norms to determine which sounds to work on first in articulation therapy, and began to see language as grammar rather than word sequences, thus paving the way for our next period in our development of language therapies?the structural linguistic approaches.