What percentage of children and young people have a profile that matches a DLD diagnosis?
7%
What is the definition of DLD?
- expressive, receptive or pragmatic language abilities in ways that are different from the majority of aged-matched peers, in the absence of a known biomedical cause or sensory impairment
- functional impact on their daily living
- develop language abilities at a slower pace, displaying developmental linguistic immaturities for a longer period, language abilities following an atypical pattern of development
- may or may not have low IQ
- difficulties in other areas- reading impairments, motor difficulties or attentional problems
- lifelong
- struggle socially, often experience MH difficulties
What is the umbrella name for developmental language disorder?
- Speech, Language and Communication Needs (SLCN)
- used for children and young people who struggle to communication, whether this is due to social or environmental causes, neuro-developmental difficulties or sensory impairment
What are some specific speech-sound disorders? (associated with DLD)
- verbal dysphraxia (CAS)
- articulation disorder
- orofacial structural defects
What may children with language disorder have difficulties with?
- phonology
- syntax
- semantics
- pragmatics and social use of language
- discourse
- verbal learning and memory
- reading and writing
- processing
How do we distinguish between children with developmental language disorder and a language disorder associated with x…?
- if it IS NOT associated with a known biomedical condition then it is developmental language disorder
- if it IS associated with a known biomedical condition the it is called a language disorder associated with X
What are examples of… ‘a language disorder associated with…’?
- known genetic condition- eg. Down syndrome, Klinefelter syndrome
- cerebral palsy
- aquired brain injury
- sensorineural hearing loss
- severe intellectual disability
- autism
What are some common co-occuring disorders with DLD?
- ADHD
- DCD- developmental coordination disorder- dysphraxia
- dyslexia
- speech
- SEMH (social emtional mental health)
What are some general considerations for children with DLD in terms of progression rates?
- often not an obvious or clear cause for the alnaguage disorder
- don’t follow the typical rate and progress of speech and language development
- these children will not catch up and the disorder will persist throughout the childs life
- some children with a language disorder will also have a significant learning disability
- some children with a language disorder will not have a significant learning disability
What leads to thinking a child has a language disorder?
- significantly impaired social and or educational functioning
- with indicators of poor prognosis
- not explained by lack of familiarity with ambient language
What are some theories of DLD?
- neuroanatomical sinature of DLD is related to a brain difference involving the basal ganglia
- central learning difference
- the role of memory
- linguistic accounts (children with DLD have trouble building grammatical structures requiring ‘syntactic movement.’)
What are the red flag indicators for poor prognosis in language development and what cautions should clinicians keep in mind?
- red flag behaviours are those which are definitely atypical for that childs stage of development
- these indicators represent the consensus view of clinicians, not empirically validated criteria
- important to stress that many children who exceed the minimum levels of language and communication nevertheless have language disorder
Between 1-2 years of age, what following features are indicative of potential difficulties with speech, language or communication?
- no babbling
- not responding to speech and/or sounds
- minimal or no attempts to communicate
Between 2-3 years of age, what following features are indicative of potential difficulties with speech, language or communication?
- minimal interaction
- doesn’t display intention to communicate
- no words
- minimal reaction to spoken language
- regression or stalling of language development
Between 3-4 years of age, what following features are indicative of potential difficulties with speech, language or communication?
- at most two-word utterances
- child does not understand simple commands
- close relatives cannot understand much of child’s speech
Between 4-5 years of age, what following features are indicative of potential difficulties with speech, language or communication?
- ‘severe’ language impairment involving both comprehension and expression is more likely to be persistent
- inconsistent or abnormal interaction
- at most three word utterances
- poor understanding of spoken language
- strangers cannot understand much of childs speech
- close relatives cannot understand mor ethan half of what a child says
From 5 years of age onwards, what following features are indicative of potential difficulties with speech, language or communication?
- difficulty in telling or retelling a coherent story
- difficulty in understanding what is read or listened to
- marked difficulty in following or remembering spoken instructions
- talked a lot but difficulties with engaging in reciprocal conversation
- many instances of over-literal interpretation, missing the point of what was meant
What is the requirement for a score on a language test to be deemed below average in ICD-10?
- score to be two standard deviations below the mean
How do you know how long your assessment needs to be?
- Tomblin et al. 5 composite scores from norm-referenced tests of receptive and expressive language in 3 domains of language
- Children with 2 or more composite scores below the 10th centile (1.25 standard deviations or more below the mean) were considered to have a language disorder
- many children identified by this criterion had not been identified by caregivers or professionals as having language difficulties. However, follow up in adolescence confirmed that children identified this way often had persistent problems
What are some of the impacts of DLD?
- anxiety
- social frustration
- strengths as well as differences
- isolation for family due to lack of awareness
- difficulties in accessing support
Why can diagnosis of DLD be difficult for speech and language therapists?
Can feel hard when:
- they’ve not been trained, diagnostic criteria are unclear, clients are complex, there is anxiety about giving the wrong diagnosis, there are not clear pathways for support, there is a concern abot stigma
Can feel easier when: colleagues provide support, it matches family needs and expectations, there are clear benefits to a diagnosis, there is a wider ‘medical model’ approach
What are some examples of features of a neurodiversity affirming approach?
- interventions that develop skills and traits linked to a fulfilling life (not normalizing an individual)
- what do children and young people want from interventions?
- changing environments so they are more inclusive
- identification of strengths
- continued advocacy and awareness
What are some potential grammar struggles for children with DLD?
- potential difficulty with verb endings
- for example, missing the regualar past tense marker- ed. for example, ‘yesterday I play with Dan’
- missing the third person singular -s. for example, ‘he run fast’
- difficulties with irregular past tense verbs such as I go-ed to the park, he falled down
- might leave out is and are or not put ‘s’ on the end of some verbs
- auxillary verbs
- later stage of sentence development- words are left out
- as they get older, they may not use complex sentence/utterance structures
(must consider dialects though)
What is the relationship between DLD and syntax?
- Children with DLD produce fewer instances of complex syntax and produce more grammatical errors within complex syntax utterances than same age peers
- difficulties with comprehending object relative causes, wh-questions, sentences with non-caonical word order, passives and other types of complex syntax
- DLD was previously characterized as a deficit in morpho-syntax but now accepted that linguistic differences go beyond this
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Understanding differences in Speech, language and communication12
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Language differences in preschool18
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Speech, language and communication needs in autism23
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Speech and Language in Down Syndrome13
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Developmental language delay29
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DLD in adolescene20
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Children's speech35
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Language development- social disadvantage23
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Profound and multiple learning disability20
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Children's literacy difficulties20
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Speech, language and communication in complex vunerabilities22
