Peer-reviewed article

The Impact of Hospitals on Language Learning: A Case Study of a 3-Year-Old Boy With Developmental Delay Who Needed Augmentative and Alternative Communication.

Gormley J, Fiala M, Weis E, Light J · 14 Jul 2026

Abstract

Purpose The purpose of this pilot study was to describe the language learning contexts experienced by a young child with global developmental delays and limited speech during an inpatient stay. Method An observational case study was completed to describe the language learning contexts during the inpatient stay of a 3-year-old child with global developmental delay. Six health care providers participated and interacted with him during the 16-hr observational period over two consecutive days. Interactions were video-recorded and coded, and researcher memos were used to describe environmental variables. Results During the observation period, the child interacted with at least one adult partner for a total of 6 hr. During the remaining 10 hr, he did not have human contact. His stay was characterized by extended periods without adult interaction interspersed with concentrated periods of linguistic input by providers during activities related to medical procedures, mealtimes, daily care, and therapy sessions. Providers were generally unfamiliar with his signals, preferences, and routine. They demonstrated general responsiveness during caregiving activities and positive affect during most interactions but responded inconsistently to his unique presymbolic communication signals. Conclusions Findings suggest that characteristics associated with the hospital experience-extended periods without adult interaction, limited access to familiar communication partners, and inconsistent responses to nonsymbolic communication-may constrain language learning opportunities for children with limited speech. These results underscore the need for developmentally appropriate strategies (e.g., adult interaction, consistent routines, augmentative and alternative communication access) to support communication access and optimize language outcomes in hospitals. Supplemental material https://doi.org/10.23641/asha.32942690.