This summary provides the key details from the document in 3 sentences: The document presents a case study of a 4-year-old girl named Tessa who is experiencing delayed language development. Testing showed that Tessa had significant deficits in both receptive and expressive language abilities, indicating she has a specific language impairment (SLI). While her pre-literacy skills and nonverbal intelligence were age-appropriate, focusing treatment on improving her verb usage could help advance Tessa's language development towards the next stage.

1. Running head: CASE STUDY #2 1
Case Study #2
Mark Temenak
A00865294
Utah State University

2. Case Study #2 2
Case Study #2
The human body truly is a miracle of evolution. While we may not have the biggest teeth
or sharpest claws to kill our prey, we possess one of the most powerful tools in the animal
kingdom that has allowed our species to survive millennia of hardships: the human brain.
It is well documented through ecological studies that plenty of other animals possess
brains, some are bigger or smaller than ours depending on the specimen in question, but the
question remains: What differentiates our human brain from the rest in the animal kingdom?
What allows humans to use tools, comprehend time, or utilize the power of language differently
than our closest surviving ancestors, the great apes? The answer is anything but straightforward,
but there are many qualities the human brain possesses that could possibly answer these
questions that have plagued neurologists, linguists, and evolutionary scientists for ages.
First, there are the energy demands the brain requires. According to Liberman (as cited in
Pence Turnbull & Justice, 2012), “Proportionally, the relative size of the human brain and its
sheer demand for energy (consuming one fifth of the metabolic resources of the body) far exceed
those of any other mammal” (p. 127). Given that humans have a proportionally larger and more
energy-demanding brain than any other mammal, what then causes the brain to require so much
power? In short, this need comes from the cerebrum which is the largest and most complex part
of the brain in terms of size and structure (Pence Turnbull & Justice, 2012). It consists of two
layers: the allocortex or older human brain and the neocortex or newer human brain (Pence
Turnbull & Justice, 2012). The former layer is about 10 percent of brain matter while the latter
is around 90 percent of brain matter (Pence Turnbull & Justice, 2012). This structure accounts
for not only the size difference between human and animal brains, but also the vast gap in
functional capabilities. Eric Holland, neurosurgeon and cancer biologist, at Fred Hutchinson

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Cancer Research Center and the University of Washington in Seattle states that humans have
more neurons per unit volume than other animals (Lewis, 2015). This is evident in the sheer
number of fissures our brain possesses. Dr. Holland goes on to state that even more intelligent
animals like chimpanzees and dolphins have folds in their cortices while less intelligent animals
like mice have smooth brains (Lewis, 2015). Another clear structural difference between animal
and human brains is the frontal lobe. It is the largest lobe in the human brain, and humans have
the largest frontal lobe out of all animals. Due to its size and quantity of fissures, it is critical to
bodily functions that make us “human”, i.e. fine/complex motor activities like speech and
executive functions like reasoning, hypothesizing, and rationalizing, to name a few (Pence
Turnbull & Justice, 2012). While trauma to the frontal lobe and other areas of the brain
associated with language like Broca’s and Wernicke’s Areas result in expected and noticeable
difficulties with various aspects of communication, there also exists a similar condition known as
a specific language impairment or SLI. This mystery of the language research community is the
focus of the case study, so let’s explore what exactly is a SLI.
Hogan, Sittner Bridges, Wymer and Volk (as cited in Chabon & Cohn, 2010) provide us
with a working definition of a specific language impairment as a patient having impaired
language abilities yet normal nonverbal intelligences and adequate stimulation. What this means
is that a child might seem perfectly “normal” in all aspects of life, but they are unable to
communicate properly. Hogan et al. (as cited in Chabon & Cohn, 2010) provide plenty of signs
of an SLI beyond just delayed language development from other researchers’ studies: word
retrieval problems (McGregor, Newman, Reilly, & Capone, 2002), omitting verb inflections
(Rice, Wexler, & Cleave, 1995), and significant deficits in expressive and receptive language
(Alt, Plante, & Creusere, 2004). These essential elements of language that are absent in a

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seemingly normal patient would make one believe that SLIs do not affect that many infants.
However, Hogan et al. (as cited in Chabon & Cohn, 2010) point out that SLIs are not rare events
as 7-10% of children in kindergarten are affected, and this affliction transcends socioeconomic
status and race. As if this information was not intriguing enough, Hogan et al. (as cited in
Chabon & Cohn, 2010) go on to highlight other scholars’ studies that support the notion that
there might be a genetic basis to this impairment, “The incidence of language disorders among
immediate family members is approximately 22%; the incidence of language disorders among
family members of a child without SLI is approximately 7%” (p. 143). Bishop, North, &
Donlan’s (1995) twin studies have also shown a possible genetic link since the risk for SLI was
heightened for monozygotic twins compared to dizygotic twins (as cited in Chabon & Cohn,
2010). All of this background information will prove to be crucial in understanding this current
case study involving a young female patient who is suffering from a SLI.
This case study paper will be divided into three main sections. The first section follows
this introduction and will be a summary of the case study that highlights the patient’s
problematic areas of language development. The second section involves a focused discussion
on a particular part of speech that would be advantageous for the patient to focus on given her
linguistic shortcomings along with possible instructional methods to improve the patient’s
overall receptive and expressive language abilities. The final section is a summary of the two
previous sections.
Summary of Case Study
The case study in question involves a preschool aged girl (54 months) named Tessa. She
had an unremarkable birth and remained healthy even after being discharged from the hospital.
Developmentally, Tessa reached the gross motor skill milestones with ease, but she displayed

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delays in her language development. According to Hogan et al. (as cited in Chabon & Cohn,
2010), Tessa produced her first word at 24 months, roughly one year behind her chronological
age group members, and she began to combine words at 2.5 years old. It is beyond debate that
Tessa is experiencing some sort of language development; therefore, like any other type of
disease or disorder, it is equally important to inspect Tessa’s environment as well as Tessa as an
individual. Even though it was mentioned earlier that SLI affects children from all
socioeconomic classes, that does not rule out the impact that parents/caregivers can have on their
children. Children are figurative sponges for language and will soak up any sort of verbal or
paralinguistic stimulation that they see and/or hear. Unfortunately, not all children are equal in
this aspect. Pence Turnbull and Justice (2012) cite Neuman (2006) who attempts to explain a 30
million word deficit between upper socioeconomic children and lower socioeconomic children:
Children’s exposure to words as a function of SES (socioeconomic status) is a striking
effect of poverty on parents’ emotional resources, which compromises the quality and
frequency of parents’ emotional resources, which compromises the quality and frequency
of parents’ conversational interactions with their children” (p. 105).
Given this information in terms of socioeconomic status and combined with the genetic link for
SLIs, Tessa’s parents, specifically her mother, provide another chapter to this story of delayed
language development.
In the case study by Hogan et al. (as cited in Chabon & Cohn, 2010), they paint a very
colorful picture in what kind of linguistic environment Tessa is immersed in. Her mother and
father both are employed; the former at a casino as a card dealer and the latter at a tire factory.
Clearly, the family is economically challenged which will have implications for Tessa’s
language development. On top of their economic status, there is Tessas’ parents’ educational

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background. According to Hogan et al. (as cited in Chabon & Cohn, 2010), Tessa’s mother
attended remedial reading and writing classes in high school but dropped out altogether, and
Tessa’s father had to repeat the fourth grade due to an unspecified reason. These past struggles
came to the fore in Hogan et al’s (as cited in Chabon & Cohn, 2010) case study as Tessa’s
mother, who said she didn’t like to read, took over an hour to laboriously fill out the necessary
paperwork for Tessa’s medical history and background. Clearly, the odds were aligned against
Tessa in terms of having a normal linguistic development. Not only is she growing up in a lower
socioeconomic household, but she has two parents who may or may not have linguistic issues of
their own, especially her mother. Since her mother does not like to read (there is no information
on her father’s reading habits), Tessa is missing a wonderful opportunity to grow and refine her
language abilities. The University of Michigan’s Health System YourChild Development and
Behavior Resources website states that reading allows for children to practice five key skills:
phonemic awareness, phonics, vocabulary, reading comprehension, and fluency (oral reading).
The University of Michigan’s Resources Guide goes on to state that, “Parents play a critical role
in helping their children develop not only the ability to read, but also an enjoyment of reading”,
and that they should lead by example by sitting down to enjoy some leisurely reading. Based off
of the evidence provided in the case study background information section, clearly Tessa was
deprived of a high quantity of quality input due to her parents’ education levels and
socioeconomic status. These factors worked in tandem with possible genetic influences to create
Tessa’s SLI.
Hogan et al. (as cited in Chabon & Cohn, 2010) mention Tessa’s mother noticed that she
was having trouble understanding Tessa’s attempt to communicate, and she noticed that Tessa
would often disengage from conversations. Tessa’s mother’s concerns were further confirmed

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from Tessa’s preschool teacher who informed her that Tessa had great difficulties describing
pictures in books and staying on topic when discussing a story. Although these struggles could
merely be attributed to the lack of reading in Tessa’s household and subsequent dearth of reading
skills, the researchers did a battery of tests in order to fully assess Tessa’s language abilities.
The tests and results from Hogan et al. (as cited in Chabon & Cohn, 2010)’s case study are
shown in Table 1 below.
Table 1. Language testing results for Tessa
Name of test Behaviors noted Scores/Outcomes
ASHA Hearing Screening N/A 20 dB for 1,000, 2,000, and
4,000 Hz in both ears.
Passed the test.
Goldman Fristoe Test of
Articulation-2
N/A 0 errors, 119 standard score,
and >92 percentile rank.
Sound system is within
normal limits for age.
Preschool Language
Scale-Fourth Edition
1. Auditory
Comprehension
2. Expressive
Communication
1. Patient could identify
colors, understand
negatives, demonstrate
appropriate use of objects in
play.
Patient struggled with
creating inferences,
identifying categories,
following directions with
cues, and recognizing
qualitative concepts.
2. Patient could use basic
word combinations (N+V,
N+V+A), quantity
concepts, and answer
logical questions.
Patient had difficulties with
using possessives, naming
1. Patient scored more than
2 SD below the mean for
her age.
Raw Score: 35
Standard Score: 65
Concern?: Yes
2. Patient scored more than
2 SD below the mean for
her age.
Raw Score: 38
Standard Score: 65
Concern?: Yes

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3. Total Language Score
objects, completing
analogies, and describing
how objects are used.
3. N/A 3. Patient scored more than
2 SD below the mean.
Raw Score: 130
Standard Score: 61
Concern? Yes
The Test of Preschool
Early Literacy
1. Print Knowledge
2. Definitional Vocabulary
3. Phonological Awareness
4. Early Literacy Index
1. Patient held books
appropriately, turned pages,
and pointed to pictures.
2. Patient could identify
simple objects and their
uses.
3. Patient could delete
initial syllables and sounds
from words and blend
sounds to form words.
4. Composite score of print
knowledge, definitional
vocabulary, and
phonological awareness.
1. Patient developing like
her age-matched peers.
Raw Score: 12
Standard Score: 92
Concern?: No
2. Within the normal range
for her age.
Raw Score: 40
Standard Score: 90
Concern? No
3. Within the normal range
for her age.
Raw Score: 14
Standard Score: 93
Concern?: No
4. Pre-reading skills were
age appropriate
Raw Score: 275
Standard Score: 90
Concern?: No
Language Sample
Analysis
Patient was friendly and
talkative.
Difficulty with grammar
and semantics.
Confused gender pronouns
like “he” and “she”.
Trouble with word retrieval

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and over-utilized “thing”
and “stuff”
The Kaufman Assessment
Battery for Children-
Second Edition
Patient was able to
recognize faces, create
matching patters, and
imitate hand movements.
Patient’s nonverbal
intelligence scores were
within normal limits when
compared to age-matched
peers.
Raw Score: 33
Standard Score: 89
Concern?: No
Given the information in Table 1, there are many conclusions that can be drawn from the
results. Hogan et al.(as cited in Chabon & Cohn, 2010) study ruled out the possibility of a
hearing impairment or lack of proper control over her articulation abilities being the causes of
Tessa’s delayed linguistic development. However, Hogan et al.(as cited in Chabon & Cohn,
2010) use of the Preschool Language Scale-4th Edition showed that Tessa had clear issues with
certain aspects of receptive language like following directions, making inferences, and
identifying qualitative features of objects. As for Tessa’s expressive language, she also was
below average as she had trouble using possessives, omitted verb tenses, and could not complete
analogies. The conversational analysis used in Hogan et al.(as cited in Chabon & Cohn, 2010)
case study only further confirmed the presence of Tessa’s SLI as she used “thing” or “stuff” to
circumlocute relatively more complex linguistic features. It became extremely clear that Tessa
had an SLI since the Test of Preschool Literacy and Kaufman Assessment demonstrated she did
not lack any literacy skills or nonverbal intelligence in comparison with children in her age
group that developed normally. Based on Brown’s (1973) stages of language acquisition and
Tessa’s age, she should be in the V+/V++ level, but her actual expressive verbal abilities do not
match. Her morphology is a low level II at best since she struggled with the possessives that are
found in level III. There is not a lot of data on her expressive question formation abilities, but

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her noun phrase and verb phrase abilities are a level III and ranges from level I to a low II,
respectively. She is able to connect nouns, verbs, and adjectives, but as previously mentioned,
did not even have proper subject-verb agreement. Ergo, complex sentences were completely
absent from her verbal repertoire. Surprisingly, she is different than a typical SLI patient given
she has normal speech pragmatics and pre-literacy skills even though it does not seem likely she
reads with her parents. However, in line with other SLI patients, she did have normal nonverbal
intelligence. Taking all of the information into account for a treatment plan, it would be
advisable to focus on verbs to eventually help Tessa reach her V+/V++ stage of development and
the story-telling communication goals stated in the case study by Hogan et al. (as cited in
Chabon & Cohn, 2010).
Verbs
While nouns are known to dominate early language learners’ vocabularies, Braunwald (as
cited in Justice & Ezell, 2008) found that verbs quickly come into use by the age of two. Nouns
are commonly known as persons, places, or things and could be considered the essential building
blocks of language or the body of the sentence. Verbs, on the other hand, are the connective
elements in sentences that give the nouns meaning in relation to each other in terms of space,
time, and or being. There are main verbs that are able to stand by themselves in terms of
describing a sentence (talk, walk, jump), and then there are auxiliary verbs that can help the main
verbs in certain tenses like the use of “be” in the progressive tenses. The verb “be” can be a
tricky prospect for anyone new to the English language. First, it is highly irregular verb
possessing three different conjugations in a simple present paradigm, and these forms bear no
resemblance to their simple past counterparts as demonstrated in Table 2 below.
Table 2. Simple Present and Simple Past Paradigm of Verb “To Be”

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Simple Present Tense (To Be) Simple Past Tense (To Be)
I am We are I was We were
You are You (pl.) are You were You (pl.) are
He/She/It is They are He/She/It was They were
Second, it could serve as either a copular verb, a version of be that denotes a state of being or
quality, or a helping verb in certain verb tenses. Regardless of its complicated conjugation and
employment in sentences, the power of the verb “be” cannot be underestimated. According to
Corpus of Contemporary American English (COCA) from Brigham Young University, the top
five most used verbs in spoken, fiction, popular magazines, newspapers, and academic texts are
all forms of the verb “to be” (in descending order): is, was, ‘s (contracted 3rd person singular
form), be, and are. The word “tense” has been mentioned a fair amount of times since beginning
this section, so it would only make sense to provide a definition for this key term used when
talking about verbs. According to Justice and Ezell (2002), tense refers to the time of the action
or state of being, and English has three tenses: past, present, and future (p. 22). What this means
is that based on the type of morphological inflection English speakers use for a verb, they can
easily convey to someone a time frame without having to use a time marker in the sentence. For
example, if one speaker said, “I ate”, the audience would know that it happened sometime before
this very moment given the use of the simple past form of the verb “to eat”. It is not absolutely
necessary to specify a period of time like “yesterday” or “two minutes ago” unless the speaker
deems it necessary or the other interlocutor demands clarification. Not only do verbs inform
listeners of time but also number and mood. Number refers to how many subjects are doing the
action or experiencing some type of state of being. In English, this concept is established by the

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use of nouns (common, proper, or personal pronouns) along with utilizing the appropriate
morphemes to align with the number of agents, i.e. the third person singular “-s” suffix in the
simple present tense. As for mood, according to Justice and Ezell (2002), this concept with
verbs can convey the speaker’s state of mind like imperatives/commands, indicative (facts), or
subjunctive (wishes or desires). These final two aspects of verbs will be important in terms of
formulating an appropriate treatment plan for Tessa.
In the case study by Hogan et al. (as cited in Chabon & Cohn, 2010), Tessa’s parents
request that she should be able to interact in everyday conversations along with being able to
produce intelligible narratives using age appropriate grammar. Therefore, using the information
in the case study along with Brown’s stages of acquisition chart, the types of verbs can be more
accurately targeted in order to maximize Tessa’s linguistic potential. First, she needs to learn
how to properly use simple present tense, especially the verb “to be” in order to develop her
abilities to identify people, work on object qualities, and everyday habits. Second, Tessa will
need to learn how to use the simple past tense, both regular and irregular, in order to relate what
happened at school and achieve the narrative goal. Regular past tense, however, is a more
feasible goal given Tessa’s condition. Another important tense for her to learn would be the
progressive, both present and past, because it is more useful than the simple present tense when
describing what is or was happening in the moment. One final verb target would be learning
how to understand and use commands, both positive and negative, since she was unable in the
case study to comprehend directions even with cues. Table 3 below shows the types of verb and
an example of each type that will be introduced to Tessa in order to improve her communication
abilities.
Table 3. English Verb Types

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Verb Tense/Mood Example Degree of difficulty
Simple Present Tense I speak English. Easy
Simple Past Tense
(Regular/Irregular)
Regular- He/She walked
yesterday.
Irregular- They ate dinner
at 9 pm last night.
Easy
Difficult
Present/Past Progressive I am dancing.
He was running.
Easy
Difficult
Commands Give me my laptop!
Please be quiet.
Easy
Simple Present Tense Verbs (Regular and Irregular)
According to Justice and Ezell (2002), simple present tense is used for actions and states
of being that are happening now and are formed by attaching an “-s” or “-es” suffix at the end in
written form. Unfortunately, this simplified definition is not adequate and should be amended to
include routines and facts (although the latter could also be considered the indicative mood)
(British Council website). In regard to routines, an example sentence could be, “I study every
morning”. The main verb “study” in this sentence conveys the idea that this individual did the
same action during a specific timeframe in the past for an unspecified number of times, will
probably do the same action in the present, and will assumedly continue this routine into the
future. Another key part of the simple present tense is the use of the verb “to be”. Its qualities
cannot be underestimated as shown in the previous paragraphs in terms of frequency and utility.
The verb “to be” is often times acquired before the third person “s” suffix based on Brown’s
(1973) stages of acquisition and a key study in terms of the saliency of the verb by Paradis, Rice,
Crago, and Marquis (2008). After comparing is, are, do, does, the “s” suffix, and “ed” suffix,
Paradis, Rice, Crago, and Marquis (2008) managed to find that “is” appeared 268,412 times per
10 million words and “are” 92,155 times per 10 million words. This was much more than the

14. Case Study #2 14
modest 61,931 “s” present suffix or the paltry “-ed” past suffix appearing 37,811 times per 10
million words. Paradis, Rice, Crago, and Marquis (2008) used these findings to hypothesize that
children learn these forms of “be” more often since they are unbound morphemes and therefore
more salient. This idea falls in line with the competition model of language acquisition that is
part of the nurture school of thought that states:
“Children acquire language forms that they hear frequently and reliably early in life, and
later in life the acquire forms that they hear rarely or inconsistently…multiple language
forms compete with one another until the input strengthens the correct representation and
the child no longer produces an incorrect form” (Pence Turnbull & Justice, 2012, p. 62)
Therefore it would make the most sense to teach Tessa how to use “to be” in all forms in the
simple present form along with other common verbs like have, do, go, say, can, want, need, eat,
drink, take, give, put, and use according to the top 20 most frequent verbs in English according
to the COCA (2015). According to Hogan et al. (as cited in Chabon & Cohn, 2010), Tessa is
able to N + V and N + V + Adj sentence forms, so she needs to practice the actual conjugation of
the verbs. The N + V + Adj form could be quite useful where she could practice the copula
version of “be” along with new vocabulary and pronouns. This is around the Level III found in
Brown’s (1973) stages of acquisition. One way to practice this idea of describing others, the
copula “be”, Tessa’s productive and receptive language skills, and her natural artistic skill would
be playing Pictionary. It would be precluded with a reading of the Dr. Seuss book One Fish,
Two Fish, Red Fish, Blue Fish. This book starts off with simple Adj + N combinations like “old
fish” and “black fish” with accompanying pictures but then transitions into copular constructions
like “Some are fat” and “Some are sad”. It could prove to be beneficial for her mother to read it
along with her because it is simple enough for both of them to practice reading it together, and

15. Case Study #2 15
Tessa’s mother should engage Tessa in asking her specific personal quality questions about the
characters in the book like, “Tessa, what color is this fish?”. Her mother could then point, and
see if Tessa can accurate produce a copular sentence with the verb “to be”. After the
introduction of the copular verb “to be”, they could play Pictionary together. Tessa’s mother
could convey a description of a character they have in their head while using “to be” and “has” to
properly relay the information to Tessa. This can test Tessa’s receptive language skills while
also harnessing her passion for creating art. Once finished, Tessa’s mother can compare the
accuracy of Tessa’s drawing to what she originally described. If she does it correctly, then they
can switch roles. Tessa can try to correctly convey the physical or mental characteristics of her
character. Another entertaining way to practice the “to be” copula along with negatives would
be to play the board game Guess Who? This could not only focus on her description skills, but
also try to improve her categorization skills (men vs. women) and inferential skills in terms of
using process of elimination in order to find out who the other player’s mystery person is. While
describing others is an important skill, especially when talking about her classmates or family
members, the simple past tense is the key to one of the case study’s main goals.
Simple Past Tense Verbs (Regular and Irregular)
Justice and Ezell (2002) define simple past tense verbs as actions or states of being that
happened at a certain time in the past. What this means is that they are closed actions that
technically are not connected to the present like the present perfect tense. The best way to
conceptualize the simple past tense is like a camera. It takes pictures of what happened in the
past. The people or objects in the pictures do not move, so it is not an ongoing action of
something that happened before now. Morphologically, there is a bit of diversity in this tense.
Justice and Ezell (2002) illustrated that regular past tense verbs use an “-ed” suffix (walked,

16. Case Study #2 16
talked) to be inflected in the simple past tense. Then there are other verbs that are irregular that
completely change their spelling in the simple past tense like “eat” changing to “ate” or “sleep”
changing to “slept”. These irregular verbs simply need to be memorized since there are no
definite rules to their construction. Although Tessa is operating at a Level I according to
Brown’s (1973) stages of acquisition in terms of verb morphology since she omits all forms of
verb tense, it would be advantageous to try to get her to use the simple past in order to reach at
least a Level III where she can include the main verb and inflect it using the “-ed” suffix, even if
it is overgeneralized. Why would Tessa need to learn the simple past tense? The answer lies in
the client’s preferences in the case study by Hogan et al. (as cited in Chabon & Cohn, 2010),
“They expressed their desire for Tessa to be able to tell stories about her day and also to share
stories, both real and make-believe, with her friends” (p. 148). The simple past tense is crucial to
relaying stories in English since they more often than not involve situations that happened before
the current moment of recounting the chain of events. This can be demonstrated by the common
introductory phrase in many children’s fairy tales, “Once upon a time…”, denoting some period
of time before the present; therefore, Tessa’s mother could of course use fairy tales like
“Goldilocks and the Three Bears” as an introduction to the simple past tense. However, there are
much more creative approaches to helping Tessa learn a proper narrative style along with the
simple past tense.
One way could be utilizing comic strips with the artwork provided but the words
removed. This exercise would see how creative and precise Tessa could be with her language
because she has visual cues in the artwork that she could use to elaborate her story. Taking it
one step further, Tessa could then be presented with a blank comic strip, and she could create her
own story given the case study by Hogan et al. (as cited in Chabon & Cohn, 2010) mentions her

17. Case Study #2 17
ability to come up with complicated tales associated with her artwork. Ideally, it could be a daily
or weekly exercise where she could continue the story like a typical comic book series, or her
mother, if she has the time, could make videos of Tessa acting out her created stories in order to
integrate role-playing and TPR into her language learning sessions. Not only does this approach
play to her strengths, it would also be an excellent way for researchers or her mother to create a
type of portfolio to track her overall progress, and Tessa could use the portfolio as a way to
maintain continuity in her new chapters with her old content. This requires higher executive
planning skills that will sharpen Tessa’s mind as well as allow her to practice the sequential and
sometimes multi-faceted nature of storytelling. One final idea could be creating a personal
timeline of her day yesterday or on a family vacation. Tessa could use personal drawings to then
tell her story about what happened, or if her family has pictures of a family vacation, her mother
could help her order them chronologically. Even though the simple past tense seems to be quite
useful when telling stories, the next tense is just as important but conveys a different sense of
time.
Present and Past Progressive Tense
If one would examine the subheading of this section, they would see familiar words like
present, past, and tense. However, there is a new element at play: progressive. Within the word,
“progressive” we can see the word “progress”, and this is the heart of the progressive tense. This
tense involves actions that are still in progress in the present or in the past. In the present, it is
hard to distinguish it from the simple present tense, but the present progressive tense signifies a
sense of immediacy or dynamism compared to the habitual or “closed” actions of the simple
present tense. The past progressive tense is no different. A clear separation of the simple past
tense and the past progressive tense is easily conceptualized utilizing the camera simile from the

18. Case Study #2 18
simple past tense section. While the simple past uses a camera to capture still images of past
actions, the past progressive tense is more like a video camera that describes the ongoing actions
in the background and foreground. Thus, storytellers, especially modern ones, could use both
tenses while using both language and their cell phone to relay a story to a listener. The
storyteller would use the video function to establish the scene like at a baby’s birthday party,
“Ok, so everyone is singing to the birthday boy”, and then would then utilize the simple past
tense when a closed action would interrupt the ongoing action, “Wait for it…right there! He
smashed the birthday cake!”. Then the storyteller might show the listener some still pictures of
the aftermath of this closed action that still happened in the past. Clearly, these are very
common tenses in everyday interactions, and ones that Tessa must master.
Justice and Ezell (2002) outline the formation of the tenses as a conjugated form of the
verb “be” followed by a present participle (base form of verb + -ing) like above, i.e. “is singing”
in the mini-story above. These verb tenses can be part of Tessa’s storytelling goals along due to
their feasibility according to Brown (1973). The present progressive tense emerges quite early at
Stages I and II. As for attempting to instruct Tessa in how to use the tenses, she could start with
watching a children’s video with plenty of action scenes that could allow for Tessa’s mother to
ask Tessa questions about what she saw in the video at specific points in order to practice the
past progressive tense. As for learning how to use the present progressive tense, her mother
could engage Tessa in conversation while she is playing. Howard, Shaughnessy, Sanger, and
Hux (as cited in Seefeldt and Wasik, 2014) provide support for this idea when they state,
“Talking is the favorite activity of four-year-olds. They talk while they are playing, frequently
describing what they are doing while playing”. Specifically, Tessa’s parents could engage in a
dialogue with Tessa about her toys or favorite games. If they want to be more creative, they

19. Case Study #2 19
could practice the progressive tenses with charades. One of her parents could act out a simple
action like, “Eating a banana”, and Tessa would have to say something along the lines of, “You
are eating a banana”. Then they would switch roles; Tessa could pick from secret picture cards
that show different actions she would recognize like run, walk, sing, eat, drink, etc. This could
allow her to connect the picture to an action to the verb tense. Engaging these different
intelligences allows for Tessa’s young brain to create new connections between concepts and
language forms. The last verb section technically is not a tense but will prove to be essential in
Tessa’s receptive and expressive language skills at home and at school.
Commands
In every language there is some form of pragmatics or particular ways of using certain
language forms in appropriate social situations. Utilizing the wrong form in a situation may
result in simply being ignored to possibly a physical altercation. Pragmatics are partially driven
by verbs utilized but what is crucial is the mood conveyed to the listener. Justice and Ezell
(2002) talk about modals being connected to mood like “might”, “could”, and “should” that deal
with a speaker’s uncertainty, ability, or recommendations, respectively, but there are also
imperatives or commands that transmit a particular mood. Commands are the base form of a
verb that tells the listener to do something specific depending on the verb like “Do your
homework!” or “Join the navy!”. Justice and Ezell (2002) include the idea that a second person
“you” singular or plural is insinuated depending on who receives the message. From the earliest
moments, we learn to follow instructions from our parents. More often than not, they provide us
with positive commands (“Keep up the good work!”), but if we do something they do not like,
they will respond with negative commands. The most common being, “Stop it!”. Therefore, in
Hogan et al.’s (as cited in Chabon & Cohn, 2010) case study it is clear that Tessa’s SLI is

20. Case Study #2 20
impairing her ability to follow directions. Creating the actual commands will be easy for Tessa
since she is currently omitting any sort of verb inflection according to Hogan et al. (as cited in
Chabon & Cohn, 2010). The problem with commands then resides in the idea that she cannot
understand them. The ideal way would be to start with basic listening games like Simon’s Says
where Tessa has to listen to her mother or father give her directions on what to do like, “Touch
your nose” or “Sit down”. This could serve as a foundation for supporting her productive skills
which she could then employ as the role of Simon, and her mother could act out what Tessa tells
her to do or not do. This allows for Tessa to test out new language hypotheses in her internal
grammar and see what her mother will do when she gives certain commands. Another fun
activity that could build on the single sentence commands of Simon Says could be a treasure
hunt. Both Tessa’s mom or dad and Tessa could take turns hiding one or many items in or
around the house. The person who hid the object then has to tell their partner directions on
where to find the different treasures. This exercises both Tessa’s receptive and expressive
language skills while adding a sense of mystery and entertainment to the learning experience. It
would also demand more cognitive acumen since it deals with one of her weaknesses: multi-step
directions.
Summary
Hogan et al.’s (as cited in Chabon & Cohn, 2010) case study outlines the case of Tessa, a
preschool aged girl who is suspected to have a specific language impediment. She was noted to
have trouble following instructions, being frustrated with communicating with others, and
omitting verb tenses. However, after doing a background study of her family, it could be
reasoned that she inherited the condition from her parents since they both demonstrated struggles
in academic environments with reading and writing skills. In addition to the genetic factor,

21. Case Study #2 21
Tessa may not be receiving the quality or quantity of linguistic input in order to fully foster
language development. Therefore, Tessa’s mother brought her to the researchers in order to
assess both her verbal and nonverbal skills in order to accurately create an effective treatment
regimen.
Based on the tests, she was ruled to not have any sort of hearing impediment that might
affect her language skills. Her pre-literacy skills, articulatory system, pragmatics, and non-
verbal skills were all normal, but she was at least two SD below average in receptive language
and expressive language. Based off of Brown’s (1973) chart of linguistic development, she
should be at least a Level V, but she ranges in the different areas from almost a Level I in verb
morphology to an Early Level IV in noun phrases. Her parents want her to focus on the two
aforementioned weak areas, receptive and expressive language, along with working on directions
and storytelling abilities. In order to maximize her treatment, special attention should be paid to
certain forms of verbs: simple present tense, simple past tense, present and past progressive
tense, and commands.
The simple present tense would allow Tessa to describe people using the copula “be”
while utilizing the pre-existing N+V+Adj. sentence forms she has. More importantly is the
simple past tense that will allow her to talk more about events that happened in the past and can
be parlayed into practicing storytelling like with drawing out stories with comics that will engage
her artistic sensibilities along with practicing the new grammar form. As for the present and past
progressive forms, these are very salient and early emerging grammatical forms according to
Brown’s (1973) chart. They are also very crucial to Tessa’s treatment goals, the present more so
than the past progressive. The present progressive tense will allow Tessa talk about what she or
other friends are doing in the moment, and this skill could be practiced through playing charades.

22. Case Study #2 22
Finally, the commands connect with the goal of Tessa being able to both follow and give
directions. The overall formation of them will be an easy task for Tessa given they do not
require any sort of inflections, and Tessa’s pragmatic skills are normal for her age. In order for
her to properly learn commands, should have plenty of practice and fun with Simon Says which
could then transition to a more complicated, multi-directional treasure hunt activity. It could
possibly also entail Tessa drawing a treasure map that combines a new grammatical form along
with her affinity for creating artwork. Hopefully all of these approaches will help Tessa
eventually improve her linguistic skill and eventually reach her peers in both expressive and
receptive language levels.

23. Case Study #2 23
References
Boyce, K. (2010). Reading, literacy, and your child.
http://www.med.umich.edu/yourchild/topics/reading.htm
Brigham Young University. (2012). Corpus of Contemporary American English. Retrieved
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British Council. (2015). Present simple. Retrieved from:
https://learnenglish.britishcouncil.org/en/english-grammar/verbs/present-tense/present-
simple
Brown, R. (1973). A first language: the early stages. Cambridge: MA.
Chabon, S.S. & Cohn E.R. (2010). The communication disorders casebook: Learning by
example. Boston: Pearson Press.
Justice, L. & Ezell, H. (2008). The syntax handbook: Everything you learned about syntax…but
forgot. Austin, TX: PRO-ED.
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Paradis, J., Rice, M. L., Crago, M., & Marquis, J. (2008). The Acquisition of Tense in English:
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Pence Turnbull, K. L. & Justice, L. M. (2012). Language development from theory to practice.
Upper Saddle River, NJ: Pearson Education, Inc.

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Seefeldt, C. & Wasik, B.A. (2006). Language development in preschoolers. Early Education:
Three, Four, and Five Year Olds Go to School (p. 48-50). Retrieved from:
http://www.education.com/reference/article/language-development-preschool-children/
Seuss, Dr. (1960). One fish, two fish, red fish, blue fish. Retrieved from:
http://www.mfwi.edu/MFWI/Recordings/One%20Fish.pdf