This paper reports findings from fieldwork in situations that brought young children and child welfare practitioners together with the aim of diagnosing and treating children's communication difficulties. The findings suggest that communication difficulties tend to be treated as a property of the individual child rather than as an emergent, contextual property of interaction. The attention will be steered from clinical definitions of "impairment" and "disability" to dynamics of social interaction, where understandings of "good" and "normal" communication play a central role. The findings have implications for current recommendations for good practice, which derive from needs-led, rights-led and skills-led approaches. (Contains 7 notes and 1 table.)