Bruce Tomblin - What's Wrong with my Baby?

BRUCE TOMBLIN

What's Wrong with My Baby?

Professor Bruce Tomblin directs research that promises a better future for thousands of children.

He seemed like a healthy baby.

The pregnancy had been uneventful. His mother, Mary, was in good health and took care of herself during the pregnancy: she had never smoked, and she gave up drinking entirely. The delivery was routine. Little Gary Baker (not his real name) sat up by the age of four months, began crawling at seven months, and was toddling around the house before he was a year old.

But something was wrong with Gary.

It showed up in little things. His mother noticed that her son seemed quieter than other babies his age. While a friend's child babbled incessantly, Gary was silent. It's true that the other child was only making meaningless sounds--"gagagaga"--but why, she wondered, didn't her son make a peep?

By the time he was a year old, Gary waved enthusiastically when someone left the room. But again, the problem was words. Mary noticed that other toddlers said "bye-bye" as they waved. Her son said nothing at all. She raised the subject with her husband, but he just told her not to worry so much. After all, he pointed out, he wasn't much of a talker himself.

"It's just the way some people are," he reassured her.

As Gary grew older, it was evident that his vocabulary lagged behind his friends'. He also seemed to have trouble forming complete sentences. The family doctor suggested a hearing test, but the results showed that Gary's hearing was normal. Despite Mary's nagging doubts about her son, there was nothing specific to point to, no diagnosis of any problem, nothing to do but hope that he developed better language skills in school.

The problems only got worse when Gary entered kindergarten, however. He played well with his classmates and enjoyed stacking blocks and playing with other toys. But Gary was quickly frustrated when activities turned to letters and sounds.

By second grade, during a conference with Gary's teacher, the Bakers were told that Gary was having great difficulties learning to read and would need special help. Even with the assistance, Gary wasn't mastering reading skills, and he continued to have problems speaking.

Gary is now in fourth grade and his troubles have spilled over into the social sphere. He is often angry or sullen. Some teachers consider him a "discipline problem." His parents are distraught and angry themselves. They don't know what's wrong with their son.

Bruce Tomblin is pretty sure he does.

Tomblin, professor of speech pathology and audiology, never would have discovered that children like Gary suffer from Specific Language Impairment, a treatable disorder, if he hadn't taken a semester's leave in 1981. After ten years of teaching and research, Tomblin needed to take a step back from the day-to-day duties of his work.

"I lacked a 'big picture' view of developmental language problems," Tomblin says. "And that's precisely what I needed if I was to make real headway in my work."

So Tomblin spent the semester reading books about the philosophy of medicine and pondering how the issues raised in that field applied to his own. There was no single epiphany, no one moment when everything made sense and Tomblin cried out "Eureka!" There was, however, a cumulative and profound effect.

"The process crystalized a number of thoughts about how we look at human conditions," he says. "That's influenced everything I've done since."

Here's a nutshell account of what he discovered: First, two ways of viewing disease predominated at that time. One camp considered illness a product of nature; the other believed disease was, at heart, a social construction. Tomblin concluded that neither view resolved the extremely complex nature of problems in language acquisition. Researchers needed to follow a scientific "middle way," taking into account both nature and nurture.

Tomblin, director of the UI's Child Language Research Center, coined the term Specific Language Impairment, or SLI, for a condition he and his team of researchers discovered. They first identified 600 kindergarten students with language difficulties and then followed them through the fourth grade. The study, which continues to track how these students are doing, is the largest and most comprehensive analysis of developmental language impairments ever done. The results of the investigation were startling, with far-reaching consequences for both students and educators.

"We found that we can predict up to 80 percent of the students who will have problems with reading in second grade, by looking at their spoken language skills in kindergarten," Tomblin explains.

SLI causes serious problems for at least 5 percent of the population, and while those problems are based on language skills, they result in a cascading list of challenges. Gary's anger and discipline problems, for example, probably stem from the frustration caused by his difficulties communicating.

It's still a bit early to talk definitively about behavior problems involving the fourth-graders in the group, since Tomblin and his colleagues are still analyzing those data. But the team has completed its work on second-grade students with SLI, and those results linking behavior and language problems appear convincing: SLI students were found to have behavior problems at twice the rate of their non-SLI classmates.

"Because of difficulties with language," Tomblin explains, "they're just not following what's going on in the classroom. And that can be profoundly frustrating."

There is good news, however. Now that Tomblin has provided the tools to identify SLI students in preschool, children can receive help early enough to mitigate or even prevent many of the disastrous downstream effects of the condition. The key is providing "language enrichment" for these children, including a systematic exposure to grammar and vocabulary in the classroom and encouraging parents to read to their children more and to talk with them at home.

His groundbreaking study on SLI students looked at a wide range of factors that potentially play a role in the condition.

"We ruled out a lot," Tomblin recalls, including, among others factors, premature delivery, complications during pregnancy, low birth weight, and maternal behaviors such as smoking or drinking. "The only factors we consistently found," he says, "were a family history of language problems and parental behavior--the parents of these children spent less time reading and talking."

After conducting studies with twins and working with genetic researchers in the UI College of Medicine, Tomblin now believes that genetics contributes about 50 percent to language impairments such as SLI. The other half comes from environmental and social factors.

Tomblin likens the acquisition of language to a card game in which any given card has only limited meaning.

"It's how the cards go together that's important," he says. "To understand something as complicated as language, you have to look at the entire hand an individual has been dealt."

Tomblin's work already has received national recognition. He has twice received the Editor's Award for article of the year in the Journal of Speech, Language, and Hearing Research. And, partly due to his efforts, the UI's Department of Speech Pathology and Audiology was rated the number-one program of its kind in the country by U.S. News & World Report. But Tomblin isn't resting on his laurels. He says he can't afford to.

"Communication skills are going to be increasingly more important as we become a society that works more with our minds and mouths rather than with our backs," Tomblin explains. "Children who can get by with a certain level of communication skills today are going to be much more at risk in society tomorrow. If we can identify their problems early on, and intervene, we can ensure that these children aren't left behind. That helps them--and it helps the society that will need their skills."