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What causes language disorders in children? There are really two answers to this question: "a lot of things" and "we don't know." Language and communication deficits are the most common result of a variety of disorders that affect mental development. We might say that language is the "final common pathway" through which a broad range of disruptions of neurological development are expressed. So there are really as many causes of language disorders as there are conditions with which language disorders are associated, and there are lots of those. Hearing impairment, Down syndrome, and fetal alcohol syndrome are just a few examples. On the other hand, many children present with disorders of language learning for which no identifiable cause can be established. These children may have specific disorders of language acquisition, with few other obvious difficulties. Or they may have language disorders associated with another condition, such as autism or nonspecific mental retardation, for which the cause is unknown. So you can see why we might say that language disorders in children have multiple causes as well as unknown origins.

Etiological classification, then, may not be the first concern of the SLP in designing language intervention. But etiology is important for preventing language disorders. To keep something from happening, we have to know what causes it; by inhibiting that cause we can avert its consequence. To prevent dental caries, for example, we need to know what makes teeth decay in the first place. To prevent language disorders, we need to know what makes them happen. So, although etiological categorization may not be the primary issue in rehabilitation of language deficits, it is central to their prevention.

Why should prevention be our concern? Are we not language pathologists, people who diagnose and treat disorders of language learning? Isn't remediation our business? Certainly it is. In all areas of health care, though, including our own (Marge, 1993), there is a national trend away from exclusive attention to rehabilitation and toward prevention efforts. This trend arises partly from our knowledge of the enormous cost of rehabilitation and the burden it places on all levels of the economy. The cost of providing special education to a child with mental retardation, for example, is estimated at more than $13,000 per year. If the child needs residential programming, the cost is closer to $25,000 per year and in some states exceeds $50,000. It isn't hard to figure out what it costs to educate and care for such a person over the course of a lifetime. In 1984, the American Speech-Language and Hearing Association (ASHA) estimated that preventing even one case of mental retardation can result in long-term savings of more than $1 million, and the figure would be even higher today. The U.S. Public Health Service (PHS), in its Healthy People 2000: National Health Promotion and Disease Prevention Objectives (Department of Health and Human Services, 1990), has established national goals for improving health, reducing risk factors, providing screening and early identification resources, and increasing public awareness and information about health and the prevention of disease. ASHA has worked with the PHS to develop 13 objectives for reducing the incidence of communication disorders. As responsible health professionals, we have an obligation to contribute to these efforts. . .

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