# data[].attributes.body
Typical Speech and Language Developmental Milstones

# data[].attributes.attachment_link.readable_text
How do speech and language develop?

The first 3 years of life, when the brain is developing and maturing, is the most intensive period for acquiring speech and language skills. These skills develop best in a world that is rich with sounds, sights, and consistent exposure to the speech and language of others.

There appear to be critical periods for speech and language development in infants and young children when the brain is best able to absorb language. If these critical periods are allowed to pass without exposure to language, it will be more difficult to learn.

What are the milestones for speech and language development?

The first signs of communication occur when an infant learns that a cry will bring food, comfort, and companionship. Newborns also begin to recognize important sounds in their environment, such as the voice of their mother or primary caretaker. As they grow, babies begin to sort out the speech sounds that compose the words of their language. By 6 months of age, most babies recognize the basic sounds of their native language.

Children vary in their development of speech and language skills. However, they follow a natural progression or timetable for mastering the skills of language. A checklist of milestones for the normal development of speech and language skills in children from birth to 5 years of age is included below. These milestones help doctors and other health professionals determine if a child is on track or if he or she may need extra help. Sometimes a delay may be caused by hearing loss, while other times it may be due to a speech or language disorder.

What is the difference between a speech disorder and a language disorder?

Children who have trouble understanding what others say (receptive language) or difficulty sharing their thoughts (expressive language) may have a language disorder. Developmental language disorder (DLD) is a language disorder that delays the mastery of language skills. Some children with DLD may not begin to talk until their third or fourth year.

Children who have trouble producing speech sounds correctly or who hesitate or stutter when talking may have a speech disorder. Apraxia of speech is a speech disorder that makes it difficult to put sounds and syllables together in the correct order to form words.

What should I do if my child's speech or language appears to be delayed?

Talk to your child's doctor if you have any concerns. Your doctor may refer you to a speech-language pathologist, who is a health professional trained to evaluate and treat people with speech or language disorders. The speech-language pathologist will talk to you about your child's communication and general development. He or she will also use special spoken tests to evaluate your child. A hearing test is often included in the evaluation because a hearing problem can affect speech and language development. Depending on the result of the evaluation, the speech-language pathologist may suggest activities you can do at home to stimulate your child's development. They might also recommend group or individual therapy or suggest further evaluation by an audiologist (a health care professional trained to identify and measure hearing loss), or a developmental psychologist (a health care professional with special expertise in the psychological development of infants and children).

What research is being conducted on developmental speech and language problems?

The National Institute on Deafness and Other Communication Disorders (NIDCD) sponsors a broad range of research to better understand the development of speech and language disorders, improve diagnostic capabilities, and fine-tune more effective treatments. An ongoing area of study is the search for better ways to diagnose and differentiate among the various types of speech delay. A large study following approximately 4,000 children is gathering data as the children grow to establish reliable signs and symptoms for specific speech disorders, which can then be used to develop accurate diagnostic tests. Additional genetic studies are looking for matches between different genetic variations and specific speech deficits.

Researchers sponsored by the NIDCD have discovered one genetic variant, in particular, that is linked to developmental language disorder (DLD), a disorder that delays children's use of words and slows their mastery of language skills throughout their school years. The finding is the first to tie the presence of a distinct genetic mutation to any kind of inherited language impairment. Further research is exploring the role this genetic variant may also play in dyslexia, autism, and speech-sound disorders.

A long-term study looking at how deafness impacts the brain is exploring how the brain "rewires" itself to accommodate deafness. So far, the research has shown that adults who are deaf react faster and more accurately than hearing adults when they observe objects in motion. This ongoing research continues to explore the concept of "brain plasticity"-the ways in which the brain is influenced by health conditions or life experiences-and how it can be used to develop learning strategies that encourage healthy language and speech development in early childhood.

A recent workshop convened by the NIDCD drew together a group of experts to explore issues related to a subgroup of children with autism spectrum disorders who do not have functional verbal language by the age of 5. Because these children are so different from one another, with no set of defining characteristics or patterns of cognitive strengths or weaknesses, development of standard assessment tests or effective treatments has been difficult. The workshop featured a series of presentations to familiarize participants with the challenges facing these children and helped them to identify a number of research gaps and opportunities that could be addressed in future research studies.

What are voice, speech, and language?

Voice, speech, and language are the tools we use to communicate with each other.

Voice is the sound we make as air from our lungs is pushed between vocal folds in our larynx, causing them to vibrate.

Speech is talking, which is one way to express language. It involves the precisely coordinated muscle actions of the tongue, lips, jaw, and vocal tract to produce the recognizable sounds that make up language.

Language is a set of shared rules that allow people to express their ideas in a meaningful way. Language may be expressed verbally or by writing, signing, or making other gestures, such as eye blinking or mouth movements.

Your baby's hearing and communicative development checklist

Birth to 3 Months

4 to 6 Months

7 Months to 1 Year

1 to 2 Years

2 to 3 Years

3 to 4 Years

4 to 5 Years

This checklist is based upon How Does Your Child Hear and Talk?, courtesy of the American Speech-Language-Hearing Association.

Where can I find additional information about speech and language developmental milestones?

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

Use the following keywords to help you find organizations that can answer questions and provide information on speech and language development:

For more information, contact us at:

NIDCD Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
Toll-free voice: (800) 241-1044
Toll-free TTY: (800) 241-1055
Email: nidcdinfo@nidcd.nih.gov

NIH Publication No. 00-4781
September 2010

# data[].attributes.attachment_link.title
Speech and Language Developmental Milestones

# data[].attributes.attachment_link.description
How do speech and language develop? The first 3 years of life, when the brain is developing and maturing, is the most intensive period for acquiring speech and language skills. These skills develop best in a world that is rich with sounds, sights, and consistent exposure to the speech and language of others.

# data[].attributes.attachment_link.title
HS231 Intro to language difficulties (1)

# data[].attributes.attachment_link.title
Tutorial Semantics assessment - 17/10/2023

# data[].attributes.attachment_link.readable_text
Fetal Alcohol Spectrum Disorder (FASD) is a disorder caused by alcohol exposure in the womb. Although it's brain-based, there are more than 400 conditions that can co-occur throughout the body and across the lifespan. Millions of people in the UK have FASD, but it remains chronically mis- or under-diagnosed.

This podcast is designed to assist people in the Speech & Language Therapy field - whether learning or qualified - to help recognise the different presentations of language and communication associated with FASD in children and make appropriate referrals to the multidisciplinary team so that they can best support the child and family's needs. Most children with FASD will have some degree of speech, language or communication need, and a Speech & Language Therapist may often be the first point of contact with a family. It is therefore important to learn the various aspects of clinical presentation, as well as understand how the disorder impacts the lives of the family members and how best to support them.

Featuring Speech & Language Therapists Rachel Jackson and Morag Burns; and Chief Executive of the National Organisation for FASD Sandy Butcher.

This podcast is also valuable for parents, carers and teachers of people with FASD, and is a Fresh Air Production on behalf of NHS Greater Manchester ICB. It was produced by Phil Sansom.

Links:
Video edition of this podcast: https://youtu.be/s7hb032Htr0
NICE Quality Standard https://www.nice.org.uk/guidance/qs204
Me & My FASD https://fasd.me/
National Organisation for FASD https://nationalfasd.org.uk/
FASD Local Alliance https://fasd-uk.net/
Fetal Alcohol Advisory Support & Training Team (FAAST) at Edinburgh University https://www.faast.ed.ac.uk/
FASD Greater Manchester https://fasdgreatermanchester.co.uk/
Greater Manchester FASD Network https://www.10gm.org.uk/fasd.html
DRYMESTER - https://www.drymester.org.uk

Fetal Alcohol Spectrum Disorder (FASD) is a disorder caused by alcohol exposure in the womb. Although it's brain-based, there are more than 400 conditions that can co-occur throughout the body and across the lifespan. Millions of people in the UK have FASD, but it remains chronically mis- or under-diagnosed.

This podcast is designed to assist people in the Speech & Language Therapy field - whether learning or qualified - to help recognise the different presentations of language and communication associated with FASD in children and make appropriate referrals to the multidisciplinary team so that they can best support the child and family's needs. Most children with FASD will have some degree of speech, language or communication need, and a Speech & Language Therapist may often be the first point of contact with a family. It is therefore important to learn the various aspects of clinical presentation, as well as understand how the disorder impacts the lives of the family members and how best to support them.

Featuring Speech & Language Therapists Rachel Jackson and Morag Burns; and Chief Executive of the National Organisation for FASD Sandy Butcher.

This podcast is also valuable for parents, carers and teachers of people with FASD, and is a Fresh Air Production on behalf of NHS Greater Manchester ICB. It was produced by Phil Sansom.

Links:
Video edition of this podcast: https://youtu.be/s7hb032Htr0
NICE Quality Standard https://www.nice.org.uk/guidance/qs204
Me & My FASD https://fasd.me/
National Organisation for FASD https://nationalfasd.org.uk/
FASD Local Alliance https://fasd-uk.net/
Fetal Alcohol Advisory Support & Training Team (FAAST) at Edinburgh University https://www.faast.ed.ac.uk/
FASD Greater Manchester https://fasdgreatermanchester.co.uk/
Greater Manchester FASD Network https://www.10gm.org.uk/fasd.html
DRYMESTER - https://www.drymester.org.uk

FASD: A Guide for Speech & Language Therapists

FASD: A Guide for Speech & Language Therapists

Fetal Alcohol Spectrum Disorder (FASD) is a disorder caused by alcohol exposure in the womb. Although it's brain-based, there are more than 400 conditions that can co-occur throughout the body and across the lifespan. Millions of people in the UK have FASD, but it remains chronically mis- or under-diagnosed.

This podcast is designed to assist people in the Speech & Language Therapy field - whether learning or qualified - to help recognise the different presentations of language and communication associated with FASD in children and make appropriate referrals to the multidisciplinary team so that they can best support the child and family's needs. Most children with FASD will have some degree of speech, language or communication need, and a Speech & Language Therapist may often be the first point of contact with a family. It is therefore important to learn the various aspects of clinical presentation, as well as understand how the disorder impacts the lives of the family members and how best to support them.

Featuring Speech & Language Therapists Rachel Jackson and Morag Burns; and Chief Executive of the National Organisation for FASD Sandy Butcher.

This podcast is also valuable for parents, carers and teachers of people with FASD, and is a Fresh Air Production on behalf of NHS Greater Manchester ICB. It was produced by Phil Sansom.

Links:

Video edition of this podcast: https://youtu.be/s7hb032Htr0
NICE Quality Standard https://www.nice.org.uk/guidance/qs204
Me & My FASD https://fasd.me/
National Organisation for FASD https://nationalfasd.org.uk/
FASD Local Alliance https://fasd-uk.net/
Fetal Alcohol Advisory Support & Training Team (FAAST) at Edinburgh University https://www.faast.ed.ac.uk/
FASD Greater Manchester https://fasdgreatermanchester.co.uk/
Greater Manchester FASD Network https://www.10gm.org.uk/fasd.html
DRYMESTER - https://www.drymester.org.uk
See omnystudio.com/listener for privacy information.

# data[].attributes.attachment_link.keywords[]
fasd: a guide for speech and language therapists

# data[].attributes.attachment_link.title
‎FASD: A Guide for Speech and Language Therapists on Apple Podcasts

# data[].attributes.attachment_link.description
Fetal Alcohol Spectrum Disorder (FASD) is a disorder caused by alcohol exposure in the womb. Although it's brain-based, there are more than 400 conditions that can co-occur throughout the body and across the lifespan. Millions of people in the UK have FASD, but it remains chronically mis- or under-d...

# data[].attributes.body
Phonological Processes are speech error patterns that can happen in typical development and are usually eliminated by a certain age.

Here's a useful chart for their names and whether they're typical or not!

# data[].attributes.attachment_link.provider_name
Sound Speech and Hearing Clinic - San Francisco

# data[].attributes.attachment_link.readable_text
Not all errors in speech are due to articulation. Sound errors can follow a pattern called a phonological process - a simplification of adult speech. All children use these processes while their speech and language develops. Young children use these simplified patterns as they learn to produce their sounds. Examples include "wa-wa" for "water", "tat" for "cat" "do" for "dog" or "ha" for "hat." Up to three years of age, these patterns are appropriate.

As children mature, so do their speech sounds and they stop using these patterns to simplify words. In fact, by age 5, most children stop using all phonological processes and their speech sounds more like the adults around them. As children stop using phonological processes, their speech becomes more understandable. This allows them to become better communicators.

Many times children do not hear the differences in the words and will say one word to mean three different ones. For example, children who continue to delete the initial consonant from a word may say "all" to mean each of these words: fall, ball, wall. This can cause frustration for the child and their communication partner, as there can be difficulty with understanding.

One of our favorite speech blogs has made a chart to help understand phonological processes! Learn more about the patterns you may hear, and the age at which we would expect them to go away!

# data[].attributes.attachment_link.title
What's a Phonological Process? - Sound Speech and Hearing Clinic - San Francisco

# data[].attributes.attachment_link.description
Not all errors in speech are due to articulation. Sound errors can follow a pattern called a phonological process - a simplification of adult speech. Learn more about these speech sound errors, and when they are expected to "go away" as a child's communication develops!

# data[].attributes.body
Rebecca Waring speaks to RCSLT about her work

# data[].attributes.attachment_link.readable_text
In this podcast we chat with Rebecca Waring, one of the authors of a paper looking at the differences between phonological delay and phonological disorder and how the disorder is linked to executive function.

The paper is:
Differentiating phonological delay from phonological disorder: executive function performance in preschoolers
Rebecca Waring,Susan Rickard Liow,Barbara Dodd,Patricia Eadie
First published: 21 January 2022
Access the paper here:
https://onlinelibrary.wiley.com/doi/abs/10.1111/1460-6984.12694

Useful resources:
CLAESSEN, M., LEITÃO, S., and FRASER, C-J., 2017, Intervention for a young child with atypical phonology. In B. Dodd and A. Morgan (Eds.). Intervention Case Studies of Child Speech Impairment (pp. 275-291). Surrey, England: J&R Press.
CROSBIE, S., HOLM, A., and DODD, B., 2009, Cognitive flexibility in children with and without speech Disorder. Child Language Teaching and Therapy, 25 (2), 250-270.
DODD, B., 2011, Differentiating speech delay from speech disorder: Does it matter? Topics in Language Disorders, 31, 96-111.

JACQUES, S. and ZELAZO, P.D., 2001, The flexible item selection task (FIST): A measure of executive function in pre-schoolers. Developmental Neuropsychology, 20(3), 573-591.

NOTES:

For RCSLT members, access this paper by navigating to the IJLCD website from our A-Z journals list here. Also, if you would like further information on the research terms used in the podcast, or many other aspects of research design, please navigate to the 'Sage Research Methods' collection from the Research Methods page of the RCSLT website'.

The interview is conducted by Jacques Strauss, freelance producer, on behalf of The Royal College of Speech and Language Therapists.

# data[].attributes.attachment_link.keywords[]
ijlcd - phonological delay versus phonological disorder

# data[].attributes.attachment_link.keywords[]
rcslt - royal college of speech and language therapists

# data[].attributes.attachment_link.title
‎RCSLT - Royal College of Speech and Language Therapists: IJLCD - Phonological Delay versus Phonological disorder on Apple Podcasts

# data[].attributes.attachment_link.description
In this podcast we chat with Rebecca Waring, one of the authors of a paper looking at the differences between phonological delay and phonological disorder and how the disorder is linked to executive function. The paper is: Differentiating phonological delay from phonological disorder: executive fun...

# data[].attributes.body
As mentioned in the RCSLT Podcast, this states that kids with a delay could abstract rules and shift (cognitive flexibility) on par with typically speaking kids. Kids with a phonological disorder struggled with both of these aspects.

Flexible Item (FIST)

# data[].attributes.attachment_link.title
Intl J Lang   Comm Disor - 2022 - Waring - Differentiating phonological delay from phonological disorder  Executive

# data[].attributes.body
Eustachian tube dysfunction combined with otitis media with effusion

# data[].attributes.body
Keynote !

# data[].attributes.attachment_link.description
Raising Awareness of Developmental Language Disorder

# data[].attributes.attachment_link.readable_text
The information on this page has been developed in response to questions asked at our DLD webinar on 4 November 2020.

To make the responses manageable, we have presented several general questions which encompass the themes coming out of questions on the day. Where possible, responses will direct you to answers within the CATALISE studies or webinar materials themselves. Written information from the presenters has been collated by RCSLT, along with information from additional sources.

RCSLT and the presenters are not able to comment on specific clinical cases, but if you feel your own question has not been covered, please get in touch.

1. What resources are available to assist SLTs in diagnosing and supporting children with language disorder/developmental language disorder (DLD)?

CATALISE resources

The two studies conducted by the CATALISE consortium are both free to access online:

Bishop, DVM, Snowling, MJ, Thompson, PA, Greenhalgh, T and The CATALISE Consortium. (2016) CATALISE: a multinational and multidisciplinary Delphi consensus study. Identifying language impairments in children. PLOS One. 11(7), e0158753.

Bishop, DVM, Snowling, MJ, Thompson, PA, Greenhalgh, T and The CATALISE Consortium. (2017) Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology. Journal of Child Psychology and Psychiatry. 58 (10), 1068- 1080.

RCSLT resources

Briefing paper (PDF) published in 2017, updated in 2020, to support therapists with the changes to terminology and criteria.

RCSLT members have access to the DLD guidance pages, including learning tools and evidence resources.

On the webinar page there are videos of the presentations, slides, written case studies and the previous webinar 'DLD - What do the changes mean for service delivery?'

Download a set of slides (PDF) that specialists can use to talk about the changes with their teams.

Other resources

The DLD Toolbox includes useful discussion and flowcharts to help with differential diagnosis.

The DLD Project provides evidence-based information for therapists, families and educators, including via the Talking DLD Podcast.

NAPLIC provide a range of resources, including an online learning package for professionals about DLD.

The RADLD, DLD and Me and Afasic websites provide support for children, families and professionals, as do Speech and Language UK.

Moor House Research and Training Institute also has information and training videos for parents and teachers, with more for SLTs coming soon.

2. What is the appropriate diagnosis for a child who has features of language disorder, in combination with phonological difficulties or speech sound disorder?

A diagnosis of DLD can be accompanied by specification of the affected domains, which include phonology ( see webinar slides PDF for a diagram). However, poor phonological awareness is not sufficient for a diagnosis, as impairments in other language skills are required.

"Where the child has a mixture of language disorder and motor or structural problems with speech production, a dual diagnosis of DLD with SSD [speech sound disorder] is appropriate." (Statement 11, Bishop et al, 2017)

It is important to remember that SSD is an "...umbrella heading either speech sound disorder...or speech sound disorders... abbreviated SSD either way" (Bowen, 2015: 4). Depending on the categorisation model employed, clinicians should then go on to transcribe and analyse the child's speech and reach a definitive diagnosis or diagnoses.

For example, Dodd's classification (2004) includes phonological delay, consistent phonological disorder, inconsistent phonological disorder, articulation disorder, or motor speech disorders such as dysarthria and dyspraxia. Helpful resources include the Child Speech Disorder Research Network website and the Ask the Experts (PDF) feature published in Bulletin (August 2019).

A learning space for SLTs supporting young children with co-occurring features of SSD and DLD launched in January 2021.

3. Can children with learning disability, learning difficulties, global developmental delay or low non-verbal IQ be diagnosed with DLD?

Susan Ebbels discussed this issue in her presentation (see particularly from slide 22/13:19) and this question was touched on in the live Q and A at the end of the webinar. Susan has also written a clarification of the RCSLT briefing paper for Bulletin.

Intellectual disability is a differentiating condition and would typically entail non-verbal IQ level below 70, as well as major limitation of adaptive behaviour. Intellectual disability is used in DSM-V and is used extensively in the US. 'Learning disability' tends to be the term used in the UK.

Where a child with language disorder has been diagnosed with a learning disability, the diagnosis would be 'language disorder associated with intellectual disability/learning disability'.

Learning difficulties is a more general term, which might be used in education, for example for a child with dyslexia, and does not necessarily indicate a differentiating biomedical condition. Global developmental delay tends to be used for younger children who have not reached milestones in two or more developmental areas.

It is not a diagnosis/biomedical condition, although it might be followed up by a diagnosis of intellectual disability or other biomedical condition. See question 4 for more discussion of cases where information is unclear or still emerging.

"A child with a language disorder may have a low level of nonverbal ability. This does not preclude a diagnosis of DLD... It is important to recognise that language can be selectively impaired in a child with normal nonverbal ability, but this statement confirms that a large discrepancy between nonverbal and verbal ability is not required for a diagnosis of DLD. In practice, this means that children with low nonverbal ability who do not meet criteria for intellectual disability (Harris, 2013) can be included as cases of DLD." (Statement 8, Bishop et al, 2017)

4. What if I need more information to determine whether a child with language difficulties has an intellectual disability or autistic spectrum disorder (ASD)?

As discussed in Susan Ebbels' presentation, diagnosis of differentiating conditions is likely to need a multidisciplinary team. It is not the SLT's role to formally assess cognitive skills or to diagnose intellectual/learning disability.

Where a child is undergoing wider assessment and seems likely to receive a diagnosis for another biomedical condition, a therapist may wish to use DLD provisionally or use 'language disorder' as an umbrella term, which can be revised to be more specific once there is more information.

However, the CATALISE studies are clear that therapists can be confident in giving a diagnosis of DLD, unless there is a known biomedical aetiology. If a differentiating condition is diagnosed later, then the diagnosis can be changed to 'language disorder associated with...'.

In all of these cases, SLTs can emphasise the degree of difficulty with language and how that might be a priority for intervention. The focus should be on the functional impact of difficulties and the needs of the child, as final diagnosis should not impact on provision.

"SLTs have an important role to play with children whose language disorder occurs with a biomedical condition. Language disorders occurring with these conditions need to be assessed and children offered appropriate intervention." (RCSLT Briefing Paper, 2017)

5. Can I diagnose DLD where a child has a diagnosis of condition not specified by CATALISE as a differentiating biomedical condition, such as dyslexia, ADHD or auditory processing disorder?

Yes.

"Co‐occurring disorders are impairments in cognitive, sensori‐motor or behavioural domains that can co‐occur with DLD and may affect pattern of impairment and response to intervention, but whose causal relation to language problems is unclear. These include attentional problems (ADHD), motor problems (developmental coordination disorder or DCD), reading and spelling problems (developmental dyslexia), speech problems, limitations of adaptive behaviour and/or behavioural, and emotional disorders." (Statement 9, Bishop et al, 2017)

"The terminology used for neurodevelopmental disorders can create the impression that there is a set of distinct conditions, but the reality is that many children have a mixture of problems. Indeed, the same problems may be labelled differently depending on the professional the child sees. For example, the same child may be regarded as having DLD by a SLT/P, dyslexia by a teacher, auditory processing disorder by an audiologist, or ADHD by a paediatrician. Given our focus on DLD, our aim with this statement was to make it clear that presence of another neurodevelopmental diagnosis does not preclude DLD." (Statement 9, Bishop et al, 2017)

"There was discussion about including auditory processing disorder (APD) as a co‐occurring condition. This category is controversial (Moore, 2006), but this should not lead to it being ignored. Children who are given this diagnosis often have co‐occurring language problems which require expert evaluation (Dawes and Bishop, 2009; Sharma, Purdy, and Kelly, 2009)." (Statement 9, Bishop et al, 2017)

Co-occurring disorders are particularly important for planning intervention. Depending on who you are reporting the diagnosis to, it may be more or less important to specify these.

6. Can I diagnose DLD where there are other developmental factors, eg trauma, effects of drugs/medication in utero?

Yes, unless there is also a differentiating condition.

"Risk factors are biological or environmental factors that are statistically associated with language disorder, but whose causal relationship to the language problem is unclear or partial. Risk factors do not exclude a diagnosis of DLD." (Statement 10, Bishop et al, 2017).

Risk factors are likely to be less important than co-occurring disorders at an individual level for predicting response to intervention. They need to be borne in mind when planning intervention, but would not usually be specified as part of a diagnosis.

7. Are there any standardised assessments or procedures that are recommended or should be included when diagnosing language disorder? What if there isn't time for a full battery of language assessments?

To provide intervention, a full picture of the child's needs is required, so it is good practice to get lots of this information prior to diagnosis, if possible. However, clinical markers (see below) may be useful as an indicator of whether more detailed assessment is required.

"Multiple sources of information should be combined in assessment, including interview/questionnaires with parents or caregivers, direct observation of the child, and standardized age-normed tests or criterion-based assessments." (Bishop et al, 2016)

"The main challenge facing those attempting to use the concept of language disorder that we advocate is that there are few valid assessments of functional language and relatively limited evidence regarding prognostic indicators." (Bishop et al, 2017)

Do what formal and functional assessment you can, state what you can conclude from what you have done and if you need more time, you need to either create or argue for this, or state that due to limited time for assessment you are not able to make a diagnosis. It may be harder to make a decision where difficulties are less severe.

In instances where formal assessment is not possible, for example due to emotional or behavioural difficulties, a diagnosis can still be made, especially if you do a language sample analysis.

Ideally, assessment would include classroom observation, but where this is not possible SLTs should at least discuss functioning with school staff and parents.

8. Are there any specific assessment scores that are used in making a diagnosis of DLD?

The CATALISE panel "cautions against defining language disorder solely in terms of statistical cut‐offs on language tests." (Bishop et al, 2017).

Different tests have different cut-off points giving the best level of sensitivity and specificity (depends on several factors, including the standardisation sample). Thus, having a single cut-point to be used for all tests, is not to be recommended.

"There is no clear cut-off that distinguishes between language impairment (regardless of its cause) from the lower end of normal variation of language ability ... Regardless of the cause, where a person's language abilities fall at the low end of the normal range, it can be appropriate to recommend intervention, ranging from environmental adjustments to specialised help, depending on the severity and nature of the problems and accompanying risk factors. However, it should be noted that many children who are judged clinically to have language impairments score within one SD of the mean on many commonly used language tests. This suggests that many instruments used to assess child language are insensitive to impairments that affect day-to-day language functioning, possibly because items can be answered using nonlinguistic compensatory strategies." (Statement 12, Bishop et al, 2016)

10. What about the impact of other skills like working memory?

Working memory and language difficulties can co-occur and interact. A child who has difficulties with both language and working memory is likely to be particularly disadvantaged. However, the current evidence indicates that working on language is more effective than working on memory.

11. If a child has pragmatic difficulties but no other language difficulties (syntax and semantics fine) and does not have ASD, should we then diagnose DLD?

Yes, but you need to be specific as to the nature of their DLD.

"Pragmatic difficulties ... are hallmarks of the communicative problems seen in ASD, but are also found in children who do not meet criteria for autism.

Specific terminology has been proposed for nonautistic children with pragmatic impairments. In ICD‐11, the term pragmatic language impairment is used as a descriptive qualifier within DLD. In DSM‐5, a new category of social (pragmatic) communication disorder (SPCD) has been introduced - see Baird and Norbury (2016).

We considered adopting the DSM‐5 term in CATALISE, but decided against this for several reasons. First, in DSM‐5, SPCD is seen as a new category of neurodevelopmental disorder, whereas we regard pragmatics as part of language, and hence pragmatic impairment as a type of language disorder. Second, the label SPCD emphasises social communication, rather than language; in contrast, our focus is on linguistic problems.

Interventions are being developed that address linguistic as well as social aspects of such communication problems (Adams, 2008), and a focus on pragmatic language as a feature of DLD should help direct children to appropriate intervention." (Statement 11, Bishop et al, 2017)

13. Are ASD and DLD seen as being on a continuum?

" For many years autism was regarded as quite distinct from other developmental language difficulties, and diagnosis of ASD would lead to a different educational/intervention pathway. However, it is now recognised that the distinction between ASD and other conditions is not as clearly delineated as some textbooks might suggest.

"On the one hand, there are children with social communication disorder/pragmatic language impairment, who have pragmatic impairments without all the features necessary for a diagnosis of ASD (see item 19).

"On the other hand, a high proportion of verbal children with ASD have language difficulties similar to those seen in non-autistic children, especially with grammar or phonology, though there is debate as to whether the similarities are merely superficial. Where structural language impairment co-occurs with ASD there are more severe problems with receptive language and functional communication.

"There is as yet no research evidence on whether intervention approaches used with language-impaired children are effective for analogous difficulties in ASD." (Statement 24, Bishop et al 2017)

14. What is best practice when working with families who have complex language backgrounds?

Examples of working with bilingual children often describe a consistent home language context. However, some families have more complex language backgrounds, with several languages spoken in the home and parents using English with their children, providing a poor language model, due to incomplete competency in this language. These children may take longer to acquire English, and therefore a differential diagnosis is more complicated. What is best practice in these cases?
The webinar prompted a useful discussion about diagnosing DLD in a bilingual child. See the additional presentation by Sean Pert about DLD in the bilingual context and relevant case studies.

RCSLT bilingualism guidance is clear that assessment in all languages the child speaks is essential to ensure a true picture of their skills. This also provides a unique opportunity for the therapist to encourage use of the home language and promote bilingualism.

It is very important to discuss with the parents that the acquisition of language requires a good model (constructivist language acquisition, see Ambridge and Lieven (2011) and Ambridge et al (2006)). The best model is the parent's home language, and they should be encouraged to use this language with the child.

Parents often believe that using English will improve the child's success in education, compared to acquiring home language(s). This myth needs to be addressed and parents reassured that children will acquire English (or the language of education, such as Welsh) more quickly if they have a firm foundation in their home language.

15. Is it appropriate to make a diagnosis when assessments have been conducted remotely?

This question was discussed in the live Q and A at the end of the webinar. Publishers of assessments may have specific advice about using their tests remotely, but even if this is possible, it is likely to be harder to assess children's functioning remotely.

Depending on the situation, it may be appropriate to say that the diagnosis cannot be confirmed until more information is gained. However, if it seems likely, then it would be better to start discussing the hypothesis and allow parents and other professionals to start thinking about it.

During the COVID-19 pandemic, the changes to remote practice have been rapid, and evidence is still in the early stages. The RCSLT has updated its guidance on telehealth and produced a range of resources for members, including on the subject of remote assessment.

17. Is limited response to intervention part of the criteria for diagnosis?

Some limited progress was referred to in the webinar case studies, as part of discussing the persisting nature of language disorder. All children are different and limited response could be due to a number of factors. It may add to the clinical picture you are building but is not imperative for diagnosis. Children with language disorder will benefit from the right interventions, but their difficulties will not completely resolve.

"The term 'language disorder' is proposed for children who are likely to have language problems enduring into middle childhood and beyond, with a significant impact on everyday social interactions or educational progress... This statement clarifies that prognosis should be a key factor in the definition of language disorder; that is, the term should include those with language problems that lead to significant functional impairments unlikely to resolve without specialist help. There is no sharp dividing line between language disorder and typical development, but we can use relevant information from longitudinal studies to help determine prognosis." (Statement 2, Bishop et al, 2017)

It is the case that some language difficulties (especially in younger children) will resolve with general intervention, and this is one of the reasons for caution in giving a diagnosis to younger children.

Courtenay Norbury gave a LuCiD Seminar in December 2020 on the topic of Stability and Change in DLD.

18. Is it possible to give a diagnosis of DLD or 'language disorder associated with X'? to children who are under 5 years?

Yes, if there are indicators of persisting difficulties. "Research evidence indicates that predictors of poor prognosis vary with a child's age, but in general language problems that affect a range of skills are likely to persist." (Statement 3, Bishop et al, 2017)

See Susan Ebbels' presentation (see particularly from slide 6/2:10) and the live Q and A at the end of the webinar. See also Susan's clarification of the RCSLT briefing paper (PDF), which appeared in Bulletin.

See also Statements 4-8 Bishop et al (2016).

20. Should traditional language units that previously focused on children with specific language impairment (SLI) now focus on children with DLD and 'language disorder associated with X'?

SLI should be removed from usage in such provisions. There will be local policy decisions around the focus of such units and the related terminology. A language unit could be appropriate for some children with associated conditions, but not for all: placement should depend on needs not diagnosis.

21. How can you record your findings and any working diagnosis for others, within time constraints?

Reports and case notes are valuable tools to share information about identified priorities and concerns, assessment, functional skills, therapy goals, strategies and how SLT and therapy partners can work to address these. They can be kept as concise as possible.

There will be times when you are uncertain, and it is perfectly acceptable to document evolving clinical hypotheses in case notes and even reports if necessary.

It is important that families are involved in discussions around diagnosis and goals and that reports are accessible to them.

22. What is recommended for assessment and diagnosis in adults?

The current evidence base in this area is very limited and has been recognised as a priority for research by CATALISE (Bishop et al, 2016) and in the RCSLT Research Priority Setting Partnership. Fidler, Plante and Vance (2011) have explored identification in adults and their paper has led some members to explore use of the Modified Token Test (Morice and McNicol, 1985) with adults in DLD diagnosis. Barry, Yeasin and Bishop's paper (2007) will also be of interest to members in this field.

The principles relating to assessment and diagnosis in children will still be applicable. You will also be able to evaluate the evidence relating to children, and draw from this, where appropriate, in conjunction with your clinical expertise and the perspective of your client, as per the EBP model.

The second CATALISE paper notes: "'developmental' can become less useful, or even confusing, as individuals grow older. One proposed solution was to drop the 'developmental' part of the term in adulthood - this is how this issue is typically handled in the case of (developmental) dyslexia, where affected adults usually refer to themselves as 'dyslexic'." (Bishop et al, 2017)

People you are working with may want to consider signing up to the Engage with Developmental Language Disorder network so they can be notified of opportunities to participate in research.

We also have a case study of an adult diagnosis (PDF).

References

Remember that many journal articles are open access or can be accessed for free by members via our journal collection.
Adams, C (2008) Intervention for children with pragmatic language impairments: Frameworks, evidence and diversity. In CF Norbury, JB Tomblin and DVM Bishop (Eds), Understanding developmental language disorders. Hove, UK: Psychology Press.

Ambridge, B, and Lieven, EVM (2011) Child language acquisition: contrasting theoretical approaches. Cambridge: Cambridge University Press.

Ambridge, B, Theakston, AL, Lieven, EV and Tomasello, M (2006) The distributed learning effect for children's acquisition of an abstract syntactic construction. Cognitive Development. 21(2): 174-193.

Baird, G, and Norbury, CF (2016) Social (pragmatic) communication disorders and autism spectrum disorder. Archives of Disease in Childhood. 101: 745-751.

Barry, Johanna and Yasin, I and Bishop, Dorothy (2007) Heritable risk factors associated with language impairments. Genes, brain, and behavior. 6: 66-76.

Bishop, DVM., Snowling, MJ, Thompson, PA, Greenhalgh, T, and The CATALISE Consortium (2016) CATALISE: a multinational and multidisciplinary Delphi consensus study. Identifying language impairments in children. PLOS One, 11(7), e0158753.

Bishop, DVM, Snowling, MJ, Thompson, PA, Greenhalgh, T, and The CATALISE Consortium (2017) Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology. Journal of Child Psychology and Psychiatry. 58 (10), 1068- 1080.

Bowen, C (2015) Children's Speech Sound Disorders. Chichester, UK: Wiley Blackwell.

Broomfield, J, and Dodd, B (2004) The Nature of Referred Subtypes of Primary Speech Disability. Child Language Teaching and Therapy. 20(2): 135-151.

Dawes, P, and Bishop, D (2009) Auditory processing disorder in relation to developmental disorders of language, communication and attention: A review and critique. International Journal of Language and Communication Disorders. 44: 440-465.

Fidler, L, Plante, E and Vance, R (2011) Identification of Adults With Developmental Language Impairments. American journal of speech-language pathology /American Speech-Language-Hearing Association. 20:2-13.

Moore, DR (2006) Auditory processing disorder (APD): Definition, diagnosis, neural basis, and intervention. Audiological Medicine. 4: 4-11.

Morice, R and McNicol, D (1986) The Comprehension and Production of Complex Syntax in Schizophrenia. Cortex; a journal devoted to the study of the nervous system and behavior. 21: 567-80.

Royal College of Speech and Language Therapists (2020) RCSLT briefing paper on Language Disorder with a specific focus on Developmental Language Disorder (PDF)

Sharma, M, Purdy, SC, and Kelly, AS (2009) Comorbidity of Auditory Processing, Language, and Reading Disorders. Journal of Speech Language and Hearing Research. 52: 706-722.

# data[].attributes.attachment_link.title
DLD - questions on diagnosis and support | RCSLT

# data[].attributes.attachment_link.description
Responses to questions asked at out webinar Developmental Language Disorder (DLD) - when is a diagnosis appropriate?

# data[].attributes.attachment_link.title
‎RCSLT - Royal College of Speech and Language Therapists: IJLCD - The impact of DLD on jury perceptions on Apple Podcasts

# data[].attributes.attachment_link.description
‎Show RCSLT - Royal College of Speech and Language Therapists, Ep IJLCD - The impact of DLD on jury perceptions - 2 May 2023

# data[].attributes.attachment_link.title
‎RCSLT - Royal College of Speech and Language Therapists: What is Developmental Language Disorder?: a discussion for DLD Awareness Day 2023 on Apple Podcasts

# data[].attributes.attachment_link.description
‎Show RCSLT - Royal College of Speech and Language Therapists, Ep What is Developmental Language Disorder?: a discussion for DLD Awareness Day 2023 - 19 Oct 2023

# data[].attributes.attachment_link.readable_text
Please find below summaries of key DLD research findings. We hope these summaries are useful in improving your understanding of DLD.

Our understanding of DLD is always evolving as more research comes out - all recommendations found below are based on evidence but may change over time as our knowledge and understanding of DLD changes.

As everyone is unique, our recommendations may not suit all individuals with DLD. Please keep this in mind!

Toseeb, U., & St Clair, M. C. (2020). Trajectories of prosociality from early to middle childhood in children at risk of Developmental Language Disorder. Journal of Communication Disorders, 85.

Our aim was to look at how children with DLD develop prosocial skills and compare their prosocial skill development to children without DLD. We looked at how prosocial skills developed from age 5 to 11. We then looked at social, behavioural and emotional outcomes at age 11 in children with DLD. We looked at these outcomes when considering different types of prosocial development in childhood.

Children with DLD had slightly lower prosocial skills at age 5, 7 and 11 years old. This was when compared to children without DLD.

We found four groups of children with different prosocial development paths from age 5 to 11. Group 1 (18% of all children) had high prosocial skills across childhood. Group 2 (35% of all children) had a stable level of prosocial skills across development, but at a lower level. Group 3 (6% of all children) had high levels of prosocial skills early in childhood, but these reduced in middle and late childhood. Group 4 (41% of all children) had lower prosocial skills early childhood, but these increased to middle and later childhood.

Children with DLD were more likely to be in the "stable low" group (Group 2) and less likely to be in the group with high prosocial skills (Group 1) across development. Children with DLD were no more or less likely to be part of the other two groups.

Individuals with DLD who were in the groups that had lower prosocial skills at age 11 (Groups 2 and 3) had more emotional, peer, conduct and hyperactivity problems at age 11.

Where can I read this paper?

This paper is open access, which means everyone can read it. Please click to find the full paper.

DLD and Socialisation Strengths and Weaknesses

Lloyd-Esenkaya, V.; Russell, A.J.; Clair, M.C.S. What Are the Peer Interaction Strengths and Difficulties in Children with Developmental Language Disorder? A Systematic Review. Int. J. Environ. Res. Public Health 2020, 17, 3140.

This study looks at research measuring how of children with DLD play or interact with other children. We were interested to know how big the studies are, where in the world they are conducted, and who took part in the research (e.g. number of boys vs girls). We also wanted to know what the research has found out about the social skills of children with DLD.

Between 1981 - 2018, 28 studies have looked at the social skills of English-speaking primary school children with DLD.

Most studies took place in America (61%) or the UK (25%). More boys than girls took part in the research.

Most studies which looked at the children's overall social skills found higher levels of peer problems in children with DLD. However, every child is different! Not all children with DLD have difficulties socialising or making friends.

Sometimes researchers watch children while they are playing and record what they see. Many children with DLD have challenges joining in with their peers. They often wait for other children to invite them to play.

Unfortunately, children with DLD are more likely to be bullied than children without DLD.

Social skills in children with DLD is under-researched. We need to do more studies with larger groups of children to be sure of the findings. Right now, it is difficult to identify key social interaction styles which will apply to lots of children with DLD.

Children with DLD are likely to need extra support for their social skills. We know social skills are important for mental wellbeing and doing well in school. Teachers need to help prevent children with DLD from being bullied.

This study has shown there are many areas we need to understand better. Why do so many children with DLD experience peer problems? Most studies of social skills have focused on children's weaknesses, so what are their strengths?

Where can I read this paper?

This is an open access paper so anyone can read it. Click for the full paper.

Do peer problems influence emotional problems?

Forrest, C. L., Gibson, J. L., Halligan, S. L., & St Clair, M. C. (2018). A longitudinal analysis of early language difficulty and peer problems on later emotional difficulties in adolescence: Evidence from the Millennium Cohort Study. Autism & Developmental Language Impairments, 3.

We wanted to find out if peer problems (difficulties with friends) had an effect on emotional problems. We used data from the Millennium Cohort Study to examine a huge group of children and adolescents. We grouped them into children at risk of DLD or children with no language difficulties. We used teacher and parent's views on social problems and emotional wellbeing. We know there are higher rates of anxious and depressive feelings in young people with DLD. We tested whether the higher rates of anxious and depressive feelings were due to difficulties socialising, not just their language skills.

The Millennium Cohort Study is a large study of children born in the year 2000-2001 from across Britain. Children and their families were first interviewed at age 9 months and then followed up every few years at age 3, 5, 7, 11 and 14. The age 17 data has just been released. Using longitudinal data like this allows us to look at developmental patterns over time. We can also get a better understanding of why changes might be occurring.

We found that even children and adolescents who are at risk of DLD, but do not yet have a formal diagnosis, experience more difficulties with social and emotional wellbeing than their peers who do not have language difficulties. We also found that this difference in emotional wellbeing between the two groups was partly 'explained' by peer problems. That is, peer problems were seen to be influencing emotional problems. This was found at age 7 and age 14. So, peer problems at age seven influenced emotional problems at age seven. Also, these peer problems at age seven influenced later emotional problems at age 14.

This paper adds to a lot of other evidence that children and young people with DLD have more difficulties with social and emotional wellbeing than their peers without language difficulties. It also tells us that having difficulties with making friends can lead to negative feelings and emotions. Supporting a child to develop positive peer relationships and friendships may help to improve their emotional wellbeing.

Where can I read this paper?

This is an open access paper so anyone can read it. Click for the full paper.

Does emotion regulation affect peer problems and emotional problems?

Forrest, C. L., Gibson, J. L., Halligan, S. L., & St Clair, M. C. (2020). A Cross-Lagged Analysis of Emotion Regulation, Peer Problems, and Emotional Problems in Children With and Without Early Language Difficulties: Evidence From the Millennium Cohort Study. Journal of Speech, Language, and Hearing Research, 63(4), 1227-1239.

We wanted to find out if children and young people with DLD develop differently from their peers in terms of social and emotional wellbeing. We know that adolescents with DLD can experience more feelings of anxiety and depression, but we're not really sure how these difficulties develop. We investigated whether a difficulty with regulating emotions in the early years could be responsible for peer problems and emotional problems in later childhood and adolescence.

Using the Millennium Cohort Study we looked at emotion regulation difficulties, peer problems and emotional problems at 3, 5, 7, 11 and 14 years old. We compared children who were 'at risk of DLD' (rDLD) to children with no language difficulties. We found that children at risk of DLD had more difficulty managing their emotions, had more problems with friends and were more likely to experience feelings of worry or sadness than children without language difficulties. Poor emotion regulation at age 3, 5 and 7 was responsible for later peer and emotional problems at age 5, 7, 11 and 14 for both groups. There was a stronger link between poor emotion regulation abilities at age 3 and emotional problems at age 5 for the rDLD group. That is, children who struggled to manage their emotions at age 3 also had more feelings of sadness and worries at age 5. This effect was stronger in the rDLD group than for the group of children without a language difficulty. A similar finding was found in middle childhood - feelings of sadness and worries at 5 years of age led to more difficulties managing emotions at 7 years of age in children at risk of DLD. We also found that peer and emotional problems were associated with each other across development. That is, children who had difficulties with friends at age 3 also experienced more feelings of sadness and worries at age 5. Similarly, those with more feelings of sadness and worries at age 3 had more difficulties with friends at age 5. So children who have fewer friends felt more sadness but also children who feel sad have fewer friends.

This paper tells us that children and young people with language difficulties, such as DLD, have more difficulties with friends and poorer emotional wellbeing. We also know that children with language difficulties have more difficulty controlling their emotions than children without language difficulties. These early difficulties controlling emotions can increase feelings of sadness and worry. This might be because they have trouble labelling emotions or experience fewer social situations where they learn to control emotions. Perhaps more focus on naming emotions and modelling social situations could help to improve social and emotional difficulties. However, more research needs to be done in this area to figure out what is causing the difficulties in controlling emotions.

Where can I read this paper?

This is an open access paper so anyone can read it. Click for the full paper.

Emotional Health and Self-Efficacy

Play, Prosocial behaviours and DLD

Evidence based pathways for interventions for children with Language Disorders

Can Positive Aspects of Emotional Competence Prevent Internalizing Symptoms?

Samson, A. C., van den Bedem, N. P., Dukes, D., & Rieffe, C. (2020). Positive Aspects of Emotional Competence in Preventing Internalizing Symptoms in Children with and without Developmental Language Disorder: A Longitudinal Approach. Journal of autism and developmental disorders, 1-13.

Previous research has suggested that children with developmental language disorder (DLD) experience a higher level of internalising problems. Internalising problems are mood problems, such depression and anxiety symptoms. In young children these can sometimes be complaints about their body, such as tummy aches. This study looks at whether positive emotions, emotional awareness, bodily awareness and communication skills protect children with or without DLD from developing internalising problems.

While better communication skills may help reduce internalising problems, positive emotions and emotion awareness still play an important role in protecting children from internalising problems. Language and communication interventions alone may not be enough to prevent or reduce internalising problems in children with DLD.

Therefore, this paper suggests that programmes and activities focusing on improving emotion awareness, alongside programmes focusing on language improvement, may be more promising in terms of reducing internalising problems in children with DLD.

Where can I read this paper?

This paper is open access, which means everyone can read it.

A possible neurocognitive explanation for DLD

Ullman, M. T., Earle, F. S., Walenski, M., & Janacsek, K. (2020). The Neurocognition of Developmental Disorders of Language. Annual Review of Psychology, Vol 71, 71, 389-417.

This paper reviews research in relation to a specific idea of what might be the brain and cognitive differences that cause DLD (as well as dyslexia and speech-sound disorders, such as stuttering). The paper looks at what is called the "Procedural circuit Deficit Hypothesis". This hypothesis states that the language learning difficulties in individuals with DLD are due to differences in the brain circuitry that supports procedural memory. However, a different memory system (declarative memory) is not affected in individuals with DLD. This paper reviews evidence that supports this idea.

Procedural memory is more developed in younger children. Declarative memory needs more time and develops across childhood. If language learning is initially reliant on procedural memory, difficulties in this system in children with DLD may cause early delays in language development.

Procedural memory has been shown to be important for grammar learning. For instance, the better a person's procedural memory, the better they use and understand grammar. However, grammar can be learned in both the procedural and declarative memory systems. As the declarative system needs time to develop in early childhood, this may be why there are delays in learning grammar in children with DLD.

Individuals with DLD have been shown to have structural differences in parts of the brain associated with procedural memory. However, researchers have not found consistent differences in the brains systems associated with declarative memory and learning. Overall, there is good evidence that problems with procedural learning may be the key problem in language learning in children with DLD.

These ideas do not mean that children with DLD can't learn from their procedural memory systems. But the ideas do indicate that their procedural learning is not as efficient as in children without DLD. Children with DLD are likely relying on the declarative learning and memory system, which tend to be used later in development. This may be why children with DLD learn language a bit later and with more effort than those without DLD.

Understanding the underlying reasons why children with DLD struggle to learn language is key for suitable therapy and treatment of DLD. Indeed, the authors suggest that there are "pharmacological, behavioural and other interventions" that can help enhance procedural and declarative memory ability. These interventions could be useful in children with DLD.

Where can I read this paper?

What elements predict concerns about the transition to secondary school?

Are young adults with DLD more or less likely to commit criminal offenses?

How aware is the public of DLD? A survey of public awareness in European Countries

Early language skills and emotional recognition in children with and without DLD

Autism Spectrum Disorder and Developmental Language Disorder

SLT experiences in diagnosis and assessing children with DLD

Can family involvement improve school adjustment in adolescents with DLD?

Rates of re-offending in young offenders with undiagnosed DLD

Listening to professionals, children and families to improve services for DLD in schools

Gallagher, A. L., Murphy, C. A., Conway, P. F., & Perry, A. (2019). Engaging multiple stakeholders to improve speech and language therapy services in schools: an appreciative inquiry-based study. BMC health services research, 19(1), 226.

Speech language therapists (SLTs) and teachers both play an important role in providing support for children with DLD in school, but they rarely work together. As a result, children with DLD may receiving less SLT service and support in school than needed. This paper aims to involve SLTs, teachers, parents and children with DLD in designing their ideal SLT service and support in school. This is done by having parents, SLTs and teachers take part in five group discussions, and having children with DLD take part in interviews.

Four key ideas appeared during the group discussions and interview:

1) The ideal support:

The ideal support should be tailored to the child's needs and interest. Tasks in school should be challenging yet possible to succeed. It is also important that the support targets difficulties other than language, such as social difficulties.

2) The ideal setting:

Parents, SLTs and teachers suggested that the ideal classroom setting should encourage listening and noticing. Children with DLD suggested that the ideal setting should be safe for taking risks, have consistent and clear rules, and allow children to have control in decisions. All the participants agreed that the ideal setting should be inclusive.

3) Priority outcomes:

Parents, SLTs and teachers said that a priority outcome is for children to connect with others. For example, children should have the opportunity to participate in class. Another priority outcome mentioned by children and parents is to understand social situations as well as other people. Other priority outcomes for children include managing their needs in school independently and learning to stand up for themselves.

4) The ideal service:

Parents, teachers and SLTs suggested that an ideal service should take the child's needs as its most important consideration. An ideal service should also be caring for the child and should involve the child and his/her parents in the process. However, SLTs, parents and teachers differed in their view of the SLTs role. While parents and teachers want the SLTs to be working in the classroom, SLTs suggested that they should act as advisors.

There are both similar and differing views between SLTs, teachers, parents and children with DLD in terms of their ideal services and supports in school. Similar views may provide a common ground for these groups to work together to improve support for children with DLD in schools.

The authors suggest that different groups might have different views because they have different experiences and a different focus. For example, children with DLD experience difficulties in school directly without knowing how supports for them are planned. Teachers and SLTs focus on planning support for children with DLD without experiencing their difficulties directly. Although these differences make it difficult for different groups to work together, addressing these differences may help improve SLT services and supports in school. So, parents are encouraged to express their views on SLT services and supports in school when suitable. Also, teachers and SLTs are encouraged to listen to children with DLD. Children should be able to have their say on the supports they are given in school.

Where can I read this paper?

This paper is open access, which means everyone can read it.

Please click to find the full paper.

Exploring sensory profiles

Simpson, K., Paynter, J., Ziegenfusz, S., & Westerveld, M. (2020). Sensory Profiles in School-Age Children with Developmental Language Disorder. International Journal of Disability, Development and Education, 1-10.

Previous research finds children with developmental conditions, such as autism and ADHD, frequently experiences sensory differences. Yet, there is little research on the sensory profile of children with DLD. This paper looks at the sensory profiles of children with DLD, and whether their sensory profiles are related to their language skills.

Sensory profile = response to sensory information (touch, taste, smell, sound, sight, balance and movement)

The findings of this paper suggest that many children with DLD face challenges in responding to sensory stimuli. This shows that children with DLD may affect multiple areas of development, not just language.

Previous studies suggested that abnormal sensory profile is related to poorer communication, and emotional/behavioural outcomes in autistic children and children with ADHD. Although little research has found similar relationships in children with DLD, identification of their unique sensory profiles may be important when providing tailored support during interventions.

Where can I read this paper?

This paper is not open access so we cannot provide a link at this time.

If you wish to read the full paper, please email E-DLD@bath.ac.uk.

Adlof, S. M. (2020). Promoting Reading Achievement in Children With Developmental Language Disorders: What Can We Learn From Research on Specific Language Impairment and Dyslexia?. Journal of Speech, Language, and Hearing Research, 63(10), 3277-3292.

Both Developmental Language Disorder (DLD) and dyslexia are disorders that can affect reading comprehension. It is now known that the disorders are different but often occur together. However, these two disorders have largely been studied separately. This paper aims to integrate research on DLD and dyslexia as well as to promote the need of considering both disorders together in the future.

More research that looks at children is still needed to improve our understanding about the characteristics and causes of DLD and dyslexia. Knowing about how DLD and dyslexia develop may help improve diagnosis and intervention for these conditions.

A core finding of this paper is the under-identification of DLD. Not only does this present a challenge for research, it also means that some children with DLD are unable to receive the help that they need. To tackle this issue, speech and language therapists should help increase awareness of the role of oral language skills on reading comprehension. Also, all children known to have reading problems should be given an assessment of their language skills. Knowing that DLD and dyslexia often occur together could help to stop DLD from being hidden.

Where can I read this paper:

This paper is open access, which means everyone can read it.

Social cognition and socio-emotional functioning

How one preschool language unit supports children

Harvey, H., & Spencer, S. (2019). Specialist provision for language disorder: Staff and service user views of a preschool language unit. Child Language Teaching and Therapy, 35(2), 93-111.

Preschool language units (PLU) are designed to support children with severe and complex language disorders in mainstream schools by providing speech and language therapy and curriculum delivery. This paper aims to understand how a PLU supports children with language disorder. Children and teaching staff are asked for their views using interviews. Parents are asked for their views using questionnaires.

The participants brought up four key points:

Teaching staff and parents suggested that the format of the PLU helped children to become more confident and helped their language skills develop. Children have mixed opinions about joining the mainstream nursery in the day. Some children enjoy having more friends and outdoor space in the mainstream section. Others prefer the quiet in the PLU.

2. The importance of relationships

Children, parents and teaching staff all found relationships built within the PLU valuable. Parents value their relationships with teachers. Children value their relationships with teachers and friends. Teaching staff value their relationships within the staff team. Teaching staff believed that good communication between a team of professionals, including a Speech and Language Therapist, was very important for supporting the children's language development.

Parents and teaching staff agreed that the PLU has a low number of pupils. Opinions on whether this is needed varied. Some thought that a bigger group would be better. Others thought that keeping a low number is more manageable for staff and pupils. Although the PLU is oversubscribed, limitations such as space, resources and class management prevent wider access to the PLU.

Parents and teaching staff considered the PLU to be preparation for moving into mainstream schools. PLU was considered important for supporting the development of children's language skills as well as other specific skills required in a school setting, such as sitting still.

The PLU in this paper is highly regarded by the children, parents as well as teaching staff, who believe the PLU gives positive early educational and social experiences. Features that are perceived to be important for the success of the PLU include: class size, consistent daily routine, approachable staff and extra support for socialising.

This paper only studied one PLU and the responses received may not apply to all other PLUs. However, this paper is useful for giving the first rich description of a specialist preschool resource base for children with language disorders.

Where can I read this paper?

This paper has been made open access, which means everyone can read it.

Peer social networks and DLD

Chen, J., Justice, L. M., Rhoad‐Drogalis, A., Lin, T. J., & Sawyer, B. (2020). Social networks of children with developmental language disorder in inclusive preschool programs. Child development, 91(2), 471-487.

Previous studies have suggested that children with DLD are more likely to struggle in social interactions and peer relations. As a result, the chances of experiencing peer rejection and victimization is concerning. This paper aims to understand the peer social network of children with DLD with their typically developing classmates in an inclusive preschool classroom.

Peer social network: play interactions formed by children within a classroom.

The findings of the paper raise concerns about the peer social networks of children with DLD, as there are nearly twice as many children with DLD experiencing isolation than typically developing children in their preschool years. The 37% rate of peer isolation in children with DLD is similar to the rate of peer interaction problems seen in older children with DLD in other studies. This suggests that problems with peer interaction commonly seen in children with DLD may appear as early as the preschool years and are likely to persist throughout childhood.

Children's peer relationships can influence their academic and social outcomes. It is important for educators to be aware of the problem of peer rejection and isolation for children with DLD. Interventions that promote social competence and social problem-solving skills may be introduced to help children with DLD develop positive peer interactions.

Where can I read this paper?

This paper is not open access so we cannot provide a link at this time.

If you wish to read the full paper, please email .

Predicting reading outcomes

Intervention for spoken language and reading difficulties

Munro, N., Lee, K., & Baker, E. (2008). Building vocabulary knowledge and phonological awareness skills in children with specific language impairment through hybrid language intervention: A feasibility study. International journal of language & communication disorders, 43(6), 662-682.

Children with DLD often struggle with spoken language and are at risk of reading difficulties. However, there is little research on interventions that target both spoken language and emergent reading abilities. This paper aims to determine whether a hybrid language intervention that targets vocabulary knowledge and phonological awareness should be further researched.

Emergent reading abilities: abilities that precedes and contributes to the development of reading skills.

Phonological awareness: the ability to use and reflect upon the sounds of spoken language. This ability is important for reading skills.

After the intervention, children improved in phonological awareness and vocabulary knowledge.

The children also improved in skills that were not targeted in the intervention, for example listening comprehension and storytelling.

The findings of this paper provide initial support for a hybrid language intervention that targets vocabulary knowledge and phonological awareness. As children with DLD have different language difficulties, hybrid language interventions can be useful as speech and language therapists can help support both their spoken and written language needs. Further research and clinical trials may help determine the effectiveness of this intervention.

Where can I read this paper?

Cell phone use in adolescents with DLD

Conti-Ramsden, G., Durkin, K., & Simkin, Z. (2010). Language and social factors in the use of cell phone technology by adolescents with and without specific language impairment (SLI). Journal of Speech, Language, and Hearing Research, 53(1), 196-208.

Mobile technology has affected how people communicate and connect with one another. While many studies have looked at the use of mobile/cell phones by adolescents, little is known about adolescents with DLD. This paper aims to compare mobile/cell phone use in adolescents with and without DLD. This paper also looks at whether language factors and social factors affect mobile/cell phone use in adolescents.

Language factors include oral language, reading, and spelling ability.

Social factors include shyness, friendships, and social motivation to use a cell phone.

Like their peers without DLD, adolescents with DLD are motivated to use mobile/cell phones for their convenience, freedom, privacy, and safety. The findings of this paper suggest that frequency of cell phone use in adolescents with DLD is not related to their language ability. The authors suggest that it is because the language requirement for communication via cell phones is more relaxed, such that adolescents with DLD do not find texting and phoning difficult.

However, adolescents with DLD text less frequently due to social factors, such as shyness and friendship difficulties. The less frequent use of texting may later reduce their opportunity for social interaction, given that texting is an important method for social connection among adolescents. It is important to address potential social difficulties when supporting adolescents with DLD.

Where can I read this paper?

This paper is not open access so we cannot provide a link at this time.

If you wish to read the full paper, please email .

Young adults with DLD: managing finances

Economic costs and benefits of Speech and Language Therapy

Tele-practice intervention

# data[].attributes.attachment_link.title
Our research | Engage with Developmental Language Disorder

# data[].attributes.attachment_link.description
Please find below summaries of key DLD research findings. We hope these summaries are useful in improving your understanding of DLD. Our understanding of DLD is always evolving as more research comes out - all recommendations found below are based on evidence but may change over time as our knowledge and understanding of DLD changes.

# data[].attributes.attachment_link.title
Webinar: DLD – when is a diagnosis appropriate? | RCSLT

# data[].attributes.attachment_link.description
Watch our recorded webinar on developmental language disorder (DLD) diagnosis in speech and language therapy services.

# data[].attributes.body
Agreement of the term DLD

# data[].attributes.attachment_link.description
Study investigating anxiety and depression in young people and adults with Developmental Language Disorder. One of the very few studies investigating adults with this condition.

# data[].attributes.attachment_link.title
Developmental language disorder and auditory processing disorder: Same or different?

# data[].attributes.attachment_caption
DLD and Attention difficulties/motor skills?

# data[].attributes.attachment_caption
Post session activity assessing morphosyntax from spontaneous language samples correction and notes

# data[].attributes.body
The CELF could be a follow on from a STASS. It is norm-referenced and in-depth. There are lots of sub-tests.

# data[].attributes.attachment_link.title
Differential Diagnosis of CAS paper - Murray et al

# data[].attributes.attachment_link.description
Dysarthria is the term used to describe the impaired speech pattern caused by brain or nerve damage to the speech muscles. A speech pathologist can assess a child's speech and provide treatment and strategies to help the child and their family.

# data[].attributes.body
https://pubs-asha-org.uniessexlib.idm.oclc.org/doi/10.1044/2022_LSHSS-22-00013

# data[].attributes.attachment_link.description
Sign in with your Essex username and password using the format username@essex.ac.uk

# data[].attributes.attachment_link.title
Introduction to Communication in Learning Disabilities 

# data[].attributes.attachment_link.description
NDTi are working with Bristol City Council to write a Learning Disability and Autism Needs assessment report.

# data[].attributes.attachment_link.title
CHANGE - Learning Disability Rights Charity - Easy Read

# data[].attributes.attachment_link.description
CHANGE is a learning disability rights charity and accessible information expert. We consult on projects, offer training and accept Easy Read commissions.

# data[].attributes.attachment_link.readable_text
Log in with a username and password?

Cookies must be enabled in your browser

Is this your first time here?

If you're an Essex user (you have a @essex.ac.uk e-mail address) use the button above to log in with your Essex ID.

Otherwise, click Don't have an Essex ID? and enter your username and password.

New student?

If you're a new student and don't yet have your login and password, you'll need to activate your account first. Click the button below to get started:
Get account information

Forgotten your password?

If you have forgotten your password, you can reset it by following the instructions from the link below:
Change password

# data[].attributes.attachment_link.description
Log in with a username and password? Cookies must be enabled in your browser If you're an Essex user (you have a @essex.ac.uk e-mail address) use the button above to log in with your Essex ID. Otherwise, click Don't have an Essex ID? and enter your username and password.

# data[].attributes.attachment_link.title
Identification of Fluency Disorders self directed study part 2 13.12.23

# data[].attributes.attachment_link.title
HS231 Introduction to stammering assessment 13.12.23

# data[].attributes.attachment_link.title
Stimulability to 2 Word Positions Assessment sheet

# data[].attributes.attachment_link.title
DEAP Inconsistancy Assessment Students Group Work 2017 (1)

# data[].attributes.attachment_link.title
Derbyshire Language Scheme (DLS) 2021 (1)

# data[].attributes.body
Non-linguistic terminology makes it more accessible to non-SLTs. But it requires special training and buying resources

# data[].attributes.attachment_link.title
Derbyshire Language Scheme - What Works review

# data[].attributes.attachment_link.title
Clinical evaluation of language fundamentals | Assessments | Services | Speech clinic | SLT for Kids | Speech & Language Therapy, across Manchester & the North West

# data[].attributes.attachment_link.readable_text
Log in with a username and password?

Cookies must be enabled in your browser

Is this your first time here?

If you're an Essex user (you have a @essex.ac.uk e-mail address) use the button above to log in with your Essex ID.

Otherwise, click Don't have an Essex ID? and enter your username and password.

New student?

If you're a new student and don't yet have your login and password, you'll need to activate your account first. Click the button below to get started:
Get account information

Forgotten your password?

If you have forgotten your password, you can reset it by following the instructions from the link below:
Change password

# data[].attributes.attachment_link.description
Log in with a username and password? Cookies must be enabled in your browser If you're an Essex user (you have a @essex.ac.uk e-mail address) use the button above to log in with your Essex ID. Otherwise, click Don't have an Essex ID? and enter your username and password.

# data[].attributes.body
Infancy (0-12 months)

Limited Babbling:

Few or no vocalizations by 6 months.

Limited variety of sounds or lack of babbling by 9-10 months.

Poor Eye Contact and Joint Attention:

Difficulty in making eye contact or engaging in shared attention with caregivers.

Limited Response to Sound:

Limited response to sounds or voices by 6-9 months.

Lack of response to name by 9-12 months.

# data[].attributes.body
Toddlerhood (12-36 months)

Delayed First Words:

No first words by 12-15 months.

Fewer than 50 words by 24 months.

Limited Vocabulary Growth:

Slow vocabulary growth between 18-24 months.

Not combining words into two-word phrases by 24 months.

Poor Understanding and Following Directions:

Difficulty understanding simple commands or questions by 24 months.

Limited response to simple directions by 30-36 months.

Limited Social Communication:

Difficulty engaging in back-and-forth play or conversations.

Reduced use of gestures, such as pointing or waving.

# data[].attributes.body
Preschool Age (3-5 years)

Limited Sentence Structure:

Use of short, simple sentences rather than age-appropriate complex sentences.

Difficulty using correct grammar (e.g., incorrect verb tenses, plurals).

Poor Narrative Skills:

Difficulty telling simple stories or describing events.

Trouble organizing thoughts coherently.

Difficulty with Pronouns and Question Words:

Incorrect use of pronouns (he/she) or question words (who, what, where).

Struggles with Understanding and Following Directions:

Difficulty following multi-step directions.

Trouble understanding complex sentences or questions.

# data[].attributes.body
Early School Age (5-7 years)

Limited Vocabulary and Word Finding:

Difficulty learning new words and retaining them.

Frequent use of vague words like "thing" or "stuff" instead of specific terms.

Grammar and Sentence Construction Issues:

Persistent grammar mistakes (e.g., incorrect verb forms, sentence fragments).

Difficulty constructing longer, more complex sentences.

Reading and Writing Difficulties:

Struggles with early reading skills (e.g., phonemic awareness, decoding).

Difficulty with writing tasks, including spelling and sentence formation.

Social Communication Challenges:

Difficulty engaging in conversations with peers.

Trouble understanding jokes, idioms, or figurative language.

# data[].attributes.body
Middle to Late School Age (7+ years)

Persistent Language Errors:

Continued grammar mistakes and limited sentence complexity.

Difficulty understanding and using advanced vocabulary.

Poor Reading Comprehension and Written Expression:

Struggles with understanding reading material appropriate for age.

Trouble organizing ideas and writing coherent texts.

Listening and Following Instructions:

Difficulty understanding and following complex instructions.

Trouble keeping up with classroom discussions and instructions.

Social Communication and Pragmatic Issues:

Difficulty understanding social cues and participating in group conversations.

Challenges with maintaining appropriate conversation topics and turn-taking.

# data[].attributes.body
General Red Flags Across Ages

Regression or Plateauing:

Loss of previously acquired language skills.

Plateauing in language development at any stage.

Behavioral Signs:

Frustration, withdrawal, or behavioural issues related to communication difficulties.

Over-reliance on gestures or non-verbal communication to express needs.

Parental or Caregiver Concern:

Parents or caregivers expressing concerns about the child’s language development.