Developmental language disorder (DLD)

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Side view of girl of school age and voice coming out of her mouth

Becky Clark looks at how we can support children with a range of language difficulties 

Difficulties with language affect children’s learning, understanding and ability to express themselves. A number of different diagnostic labels have been used to describe these issues and this has contributed to limited awareness and understanding amongst professionals and the general public. 

In order to raise the profile of the condition, in 2012 I got together with a group of professors (Dorothy Bishop, Gina Conti-Ramsden, Courtenay Norbury and Maggie Snowling) in the UK and Natalie Orringe, a public relations consultant, to create a series of accessible films for professionals and parents to help build understanding of these common, yet often hidden, conditions. The films gained a great deal of interest in the UK and globally, being used in teacher training sessions and shared online through social media. However, we were still challenged by the continued issue of terminology; it’s hard to achieve awareness effectively if we don’t have agreement on what we are raising awareness of! We also became aware that use of a variety of terms impacted on accessing information and interventions for a child and a common term is needed so parents can find communities for support. 

A recent consensus process (2016 to 2017) led by Professor Dorothy Bishop of Oxford University, brought together experts in the field to address the terminology issue. A set of criteria was established, the term “developmental language disorder” (DLD) was agreed upon and subsequently, the Royal College of Speech and Language Therapists endorsed these recommendations. 

Once an agreed term was in place, raising awareness gained new impetus and now speech and language therapy departments across the UK are using the agreed criteria and the term DLD is gaining traction in schools. 

Diagnosing DLD 
The overarching diagnostic criteria for DLD are that: 

  • the language difficulties create obstacles to communication or learning in everyday life 
  • the problems are unlikely to, or have not resolved by five years of age 
  • the problems are not associated with a biomedical condition, for example, a genetic condition or autism spectrum disorder (ASD). 

A speech and language therapist (SLT) can diagnose DLD and this can be done without the need for an assessment by an educational psychologist in relation to non verbal IQ. An important part of the diagnostic process is gathering information from professionals and/or parents and understanding how the child’s language profile is affecting their functioning in everyday life and learning. 

Why educators need to know about DLD 

  • DLD is common and affects approximately 7.5 per cent of children, which equates to approximately two children in every classroom. 
  • DLD may not be obvious and may be masked by other associated or secondary issues. 
  • Language skills are absolutely key for learning across the curriculum, including understanding of concepts, acquiring knowledge and using reasoning skills. Language skills are predictive of academic success. 
  • Difficulties are likely to be persistent across a child’s life, so it is essential that educators from early years to post- 16 have a good understanding of DLD. 
  • Oral language and literacy are closely related and interdependent. Children with DLD often have problems understanding what they read and many children with DLD also meet criteria for dyslexia. 
  • Children’s difficulties need to be identified and supported to improve a wide range of outcomes. Studies have shown that teenagers with language difficulties are 2.5 times more likely to report symptoms of depression, and at school entry, teachers reported that children had more symptoms of social, emotional and behaviour problems. Children with DLD are at higher risk of friendship issues and DLD is associated with higher rates of unemployment and lack of independence. 

As a speech and language therapist, I have seen direct evidence of how language and related literacy difficulties can affect a child’s emotional wellbeing and self image. Harry – a funny, bright and sociable young man – drew a picture of himself in a classroom. Harry drew a “bad work board” with his work posted across it, a house point chart with Harry’s name at the very bottom, and children in the class having fun with one boy in the corner, facing the wall, crying. The picture didn’t in any way reflect the physical reality of the classroom but gave us an insight into Harry’s view of himself and his feelings about school. 

DLD profiles
Language development is complex and multi-dimensional. Each child with DLD will have a different profile of skills and difficulties. 

Potential signs of DLD at school or college 
Schools should refer children with signs of DLD to speech and language therapy services for an assessment. But what are the signs to look out for? 

Signs of DLD 

  • Difficulties learning and remembering new words such as curriculum subject words. For example, the language of science and maths can be challenging. 
  • Problems with reading comprehension (which can be masked if the child has good decoding skills). 
  • Spoken explanations or written language can be hard to follow and the child may make grammatical errors. 
  • Apparent difficulties with listening or paying attention. 
  • Appearing to understand but having difficulties carrying out instructions, “forgetting” information or not completing language-based homework tasks. 
  • Misunderstandings with peers, for example due to not understanding the rules of a new game. 
  • Frustration, avoidance or withdrawal. 

Tips for teachers supporting children with DLD 

Consider spoken communication and written materials 
How quickly do you speak and how complex is your language? Do you explain things explicitly for children who may not “read between the lines”? Changing our own communication takes self-reflection, intention to change, feedback from others, and practice. Professionals are likely to need specific and structured coaching to make adjustments to their own communication. 

Simple changes to the language of written materials may mean a child can follow instructions and attempt a task rather than getting stuck interpreting what they are required to do. 

Use visual and practical strategies
Consider if the use of visual support or practical demonstrations can take the place of or supplement spoken instructions. Provide pictures, symbols or key words on the board for the children to see and refer back to. Demonstrate activities where possible rather than relying on wordy explanations. Check the child has understood by asking them to tell or show you what they need to do. Most importantly, create a classroom environment where not understanding is OK, and asking for repetition or explanation is seen as a positive strategy. 

Support language development 
Simplification and visual/practical supports for understanding need to be complemented with methods to purposefully support and scaffold development at the child’s current level. Techniques include asking open questions, extending the child’s answers and modeling language structures using visual support where possible. Schools need to identify the vocabulary essential to accessing a topic and provide additional and explicit teaching of words. 

The future for DLD
Given the relationship between language and outcomes for education, literacy and mental health, it is essential DLD gains a high level of attention within education. Schools should draw upon the expertise of speech and language therapists and specialist teachers, develop expertise within their schools and develop the knowledge and skills of all teaching staff. 

It is encouraging to see the progress made with awareness of DLD in recent years. Children with DLD deserve our understanding and schools are increasingly recognising the relationship between language skills and good outcomes. We need to keep talking about DLD. 

About the author 
Becky Clark runs ClarkSLT, speech and language therapy services for schools in SE England and via teletherapy, and was co-founder and editor of the RADLD YouTube campaign (previously called RALLI), which created short films for professionals and parents on children’s language difficulties 
www.clarkslt.co.uk 
@BeckyClark22 

You Tube: (search) RADLD 

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