Developmental Language Disorder

Developmental Language Disorder (DLD): One of the most common reasons children are referred for therapy.
Diagnosis: Based on exclusion criteria; all other causes of language impairment must be ruled out first.
  - Must have difficulty with receptive and/or expressive language likely to persist.
  - Nonverbal IQ of 70 or higher (indicating no intellectual disability).
  - Normal hearing.
  - No evidence of a neurological disorder.
  - No other known diagnosis (e.g., Autism Spectrum Disorder (ASD), Down Syndrome, etc.).
Can co-occur with difficulties in:
  - Attention
  - Motor control
  - Speech
  - Executive function
  - Auditory processing disorders.
Language disorder must be unexplained by any other diagnosis that has potential to persist beyond preschool years and impact school and job success.

Confusion in Terminology: Practitioners may refer to DLD by various terms including:
  - Specific language impairment
  - Late language emergence
  - Language disorder
  - Social/pragmatic disorder.
According to the DSM-5:
- Children qualify for a language disorder with persistent difficulty with expressive and/or receptive language.
- Must be substantially below age expectations.
Social (Pragmatic) Communication Disorder: Applicable for children with difficulties in social aspects of language but do not meet criteria for ASD.

Prevalence of DLD: Approximately 7.5%.
Gender Discrepancies: Some studies indicate males have DLD at a ratio of 1.22:1 compared to females; other studies find no correlation.
Genetic Factors: Research has identified a gene locus linked to individuals with speech and language impairments.
Environmental Factors: A child's environment also affects language development.

Children with DLD primarily struggle with morphosyntax, affecting:
  - Verb forms (third person singular, past tense -ed, copula verbs like is/are, auxiliary verbs).
  - Articles (the, a).
  - Possessive ‘s.
  - Pronouns.
Due to a primary deficit in morphosyntax, secondary effects can impact other aspects of language and academic ability.

African American English (AAE): Children who speak AAE are often misdiagnosed with DLD due to the misunderstanding of linguistic features.
- Example AAE feature: Plurality (e.g., “There are two book” can be viewed as error).

Vocabulary Development: Difficulty with semantics leading to:
- Producing word combinations less frequently than peers.
- Limited ability to use verbs (smaller variety) and having an overall smaller vocabulary.
Pragmatic Development: Negatively impacted; for example:
  - Younger children less likely to initiate topics.
  - Older children struggle to join peer conversations and to repair communication breakdowns.
  - Higher incidence of phonological impairments (up to 40% of children with DLD).

Information Processing: Research indicates children with DLD have:
  - Capacity limitations in cognitive processing resources.
  - Slower rates of ability to name pictures or recognize words.
  - Difficulty with non-word repetition tasks (e.g., repeating nonsense words).
Attention Deficit/Hyperactivity Disorder (ADHD): Approximately 22% of children with DLD also meet ADHD criteria.

Reading Problems: About 80% of children with DLD experience reading difficulties.
- DLD and dyslexia are linked.
- Difficulty with phonological awareness (detecting, segmenting, blending word sounds) which hampers the ability to decode text.

Writing Challenges: Frequent grammatical errors in writing along with difficulties in written verbal morphology.
- Struggles in writing complex sentences.

Logan, a 2nd grader diagnosed with DLD, experiences challenges with morphosyntax:
- Difficulty with complex sentences, particularly with causal conjunctions like “because” and “if.”
- Frustration during science activities related to states of matter due to language deficits affects social interactions and engagement.
Discussion Questions for Logan:
  1. What language skills are needed for science inquiry?
  2. How might Logan’s morphosyntax deficits impact his semantic development?
  3. How might Logan’s morphosyntax deficits impact his pragmatic development?
  4. How might the clinician support Logan’s academic skills?

Zachary, a 10-year-old fifth grader, faces certain challenges:
  - Well-liked socially and enjoys topics of interest (e.g., rap music, video games) but struggles with following complex verbal instructions.
  - Late in developing decoding skills (third grade) and still a slow reader with poor comprehension in fifth grade.
  - Writing consists predominantly of simple sentences produced slowly.
  - Parents unsure of approaches to enhance his participation and improve his reading/writing.
Discussion Questions for Zachary:
  1. What might be the underlying cause of Zachary’s communication style (e.g., avoiding unfamiliar topics)?
  2. What classroom-based assessments might be beneficial for understanding Zachary’s abilities?
  3. What information could be shared with Zachary’s parents to help them understand his abilities?
  4. What educational or communication goals could be included in an intervention program for Zachary?