A comprehensive approach to assessment and treatment of severe developmental speech and language disorders is discussed based on clinical experience with 69 children between 2 1/2 and 7 years of age. Assessment involves the integration of many variables, including differentiation between linguistic competence versus performance, diagnosis, familial and environmental factors, and pragmatics. A framework is presented that distinguishes therapy goals from therapy styles. The three possible goals are elimination or alleviation of causal factors, increase of interpersonal language interaction, and treatment of specific linguistic problems. These goals can be achieved within the context of three possible therapy styles: structured formal therapy, directed stimulation in play, and free play. The decision regarding choice of goals and styles is based on an integrative assessment, with the result that the treatment plan is appropriately designed for each individual.