Notes on DLD Etiology, Developmental Descriptive Model, and Functional Goals

Etiology of Developmental Language Delay (DLD)

• DLD refers to developmental language delay as a diagnosis; terms like language difference or language disorder are often used interchangeably in practice, but the key is recognizing the etiology (cause or origin).
• Etiology for some children is known; for others there may not be one single indicator. Instead, it’s often a combination of factors.
• One challenge highlighted: the child’s cognitive system in hearing, remembering, and then incorporating language into understanding and expression. In other words, language emerges from broader cognitive processes (hearing/listening, memory/retention, and integration into meaning and expression).
• Three models of assessing/understanding language disorders are mentioned, with emphasis on one primary model:
  • The developmental descriptive model (preferred in the discussion).
  • Other models are referenced but not elaborated in detail; the focus remains on using a developmental framework.
• A key methodological principle: anchor assessment in knowledge of typical language development. Use typical developmental milestones as a benchmark to evaluate deviations.
• All children progress through typical stages of language; children with Down syndrome may reach these milestones more slowly but still follow the same developmental sequence.
• Practical implication: instead of labeling a group as “language-disordered” with broad generalizations, build a detailed, individual profile informed by typical development, then tailor assessments to that profile.
• Example cue from the lecture: a child ( Diego ) around seven years old, using short utterances (two- to three-word sentences) yet requiring a detailed profile to guide assessment decisions.
• Conceptual reminder: avoid focusing on a single deficit in a complex system; language development is multifaceted and may involve broader cognitive, linguistic, and social factors.
• The broader picture matters: some language impairments (like SLI) require looking beyond simple one-issue explanations to understand how language is produced and used in real contexts.
• A mnemonic example used to illustrate processing and language retrieval is the contrast between certain familiar foods (Crisp and Hoops) used to discuss how unfamiliar or missing words can be, and how exposure and context influence language learning.
• Developmental Impairment and SLI:
  • SLI requires looking at a broader picture of language use rather than isolating one feature; the speaker emphasizes avoiding a singular remedy and instead considering multiple interacting domains.
  • The discussion also underscored that vocabulary gaps, grammar, and sentence structure can all be areas of need, not just a single deficit.
• Takeaway: assessment and intervention should be grounded in a developmental-descriptive approach, using typical milestones as reference points, and tailored to the child’s own trajectory and environment.

Case Example: Diego (developmental profile and assessment considerations)

• Diego is described as seven years old and tall for his age, using two- and three-word sentences.
• The goal of a detailed profile is to inform the assessments you perform, rather than relying on a generic label of language disorder.
• The clinician emphasizes building a comprehensive picture of what Diego can do, which informs targeted intervention goals and methodologies.

Case Example: Michael (SLI, early history, and therapy outcomes)

• Early diet and exposure context:
  • A reference to “Crisp” (sour cream and onion chips) and “Hoops” (SpaghettiOs) is used to illustrate early language experiences and how particular contexts or items may stand out in a child’s early language environment.
  • Michael moved to the United States at about age five, with early language exposure shaped by his surroundings.
• Timeline of concerns and referral:
  • By about three-and-a-half years old, there were concerns about understanding and communication; referred to a speech and language therapist around age four, especially when entering full-time school.
  • Initial lack of clarity about what Michael needed highlights a common experience for families before therapy begins.
• Role and setting of the Speech-Language Therapist (SLT):
  • SLTs work with children and adults with communication difficulties across settings (hospital, school, community clinic).
  • For a child like Michael with fluency in English but with specific language impairment (SLI), therapy is often school-based and may require more specialized supports to develop language skills.
• Typical therapy targets and skills:
  • Understanding meanings of words (vocabulary development) that the child hasn’t picked up through natural exposure.
  • Understanding different sentence types and using words appropriately within sentences.
  • Work on phonological aspects and sentence-building as part of broader language goals.
  • Specific word comprehension and production examples: clarifying the meaning of words that the child cannot retrieve (as in centipede vs. centi- words) and understanding the difference between closely related terms.
• Language sample observations often reveal missing connective or function words:
  • Example observed: Michael often left out linking words such as “because,” “and,” and “but” in sentences (e.g., “I like chocolate cake, but I don’t like celery”).
  • These omissions affect sentence cohesion and overall intelligibility.
• Therapy strategies and self-advocacy:
  • A key strategy taught early in therapy: actively indicate misunderstanding (e.g., raising a hand and saying, “I didn’t understand that; could you explain that differently?” or “What does that word mean?”).
  • Developing self-awareness of difficulties and strengths is central to SLI therapy; this helps build confidence and self-advocacy.
• Benefits of therapy for Michael:
  • Increased confidence to speak up in class and with teachers.
  • Improved ability to express messages clearly, leading to better participation in learning activities.
  • Therapy provided a functional path to living a more normal, communicative life and achieving academic goals.
• Impact on families and teachers:
  • The SLT’s role includes educating and supporting parents and teachers to understand the child’s difficulties and to implement appropriate language-support strategies in different settings.
  • The therapist’s guidance translates into practical classroom and home strategies, giving families tools to support language development.
• Real-world perspective on classroom observation:
  • Teachers may misinterpret Michael as being inattentive; collaboration helps reframe behavior as language processing needs rather than willful inattention.
  • Teachers observe grammar and speech in the classroom context and consider how language difficulties influence learning tasks (grammar, reading, comprehension).
• Eligibility considerations:
  • When evaluating a child, consider how language difficulties will impact academic standing and performance.
  • If communication skills impede accessing learning and completing language-related tasks, this informs the eligibility assessment.

Role of goal-setting, assessment, and therapy planning

• Before discussing assessment, the focus shifts to developing language goals aligned with functional outcomes, leveraging textbook guidance and practical resources (e.g., Mark Bay’s concepts on developing goals).
• Developing language functional goals emphasizes:
  • Efficiency: focusing on goals that yield the greatest communication benefit in the shortest amount of time.
  • Child-centeredness: prioritizing goals that relate to real-world communication needs.
  • Real-world context: ensuring goals translate to functional use outside of therapy sessions.
• Concepts linked to practical implementation:
  • Functional goals should be grounded in daily classroom and home activities (e.g., a functional game in the classroom that requires real communication).
  • Exit questions and reflective prompts (e.g., asking the child what they learned today and whether they used it in class) help assess functional uptake.
  • Goals should be aligned with the child’s zone of proximal development (ZPD): ensuring targets are within the child’s current capabilities but still challenging.
  • There should be a balance between new language forms and functions and what is most salient for the child’s communication needs.
• Connecting assessment tools to goals:
  • The chosen assessment tools should align with the identified goals and the child’s current abilities and needs.
  • The plan should be iterative: collect data on progress toward goals and adjust as needed.
• Classroom and family collaboration:
  • Teachers and parents are integral to implementing and reinforcing functional goals.
  • Observations from teachers, as well as feedback from families, guide goal prioritization and data collection methods.
• Example goals for a hypothetical student (Alex):
  • Identify and list at least six potential communication goals for Alex.
  • Classify each goal by priority: High, Moderate, or Low.
  • Create a supporting PowerPoint presentation to communicate goals and plan.
  • The steps for Alex’s team to follow include: (1) identify goals, (2) prioritize, (3) document them, and (4) present a plan.
• Practical steps for note-taking and portfolio building:
  • Use the team approach to fill in goal details and evidence.
  • The portolio should capture rationale, goals, data collection methods, and evaluation results.
• Summary takeaway:
  • Goals are an actionable bridge between assessment findings and real-world communication improvements.
  • The process is collaborative (student, family, teachers, therapists) and centered on functional outcomes that enhance everyday communication.

Key concepts and terminology to remember

• DLD, language difference, language disorder: terminology often used interchangeably; focus is on etiology and appropriate intervention.
• Etiology: causes or origins of language delay; often multifactorial, with some known indicators for some children and none for others.
• Developmental descriptive model: a framework that anchors language assessment in typical developmental milestones and child-specific profiles.
• Typical development baseline: using amassed knowledge about how children normally acquire language to interpret deviations.
• Zone of Proximal Development (ZPD): the difference between what a learner can do unaided and what they can do with guidance.
• SLI (Specific Language Impairment): a language impairment not attributable to a broader developmental disorder; requires considering broad language functioning rather than one isolated deficit.
• Functional goals: goals aimed at real-world, practical communication improvements, prioritized for greatest impact and efficiency.
• Real-world context: ensuring goals translate beyond therapy into daily interactions at home and school.
• Data collection and progress monitoring: systematic gathering of evidence to support goal attainment and inform adjustments.
• Exit questions: prompts used to gauge what a student learned and whether it was applied in class.
• Phonology and word usage: vocabulary expansion, understanding word meanings, sentence types, and proper word usage within sentences.
• Collaboration: ongoing coordination among SLPs, teachers, and families to support language development.

Practical implications and takeaways

• Use a developmental-descriptive lens to evaluate language primarily through a child’s profile against typical milestones.
• Recognize that language delay can be multifactorial; tailor interventions to the child’s cognitive processing, exposure, and environment.
• Early therapy and ongoing collaboration with families and teachers can boost confidence, communication effectiveness, and academic engagement.
• When designing goals, prioritize functional, real-world communication gains that can be demonstrated through everyday activities and classroom participation.
• Data-driven goal setting and frequent progress checks are essential to determine effectiveness and to adjust goals as needed.
• Prepare for a team-based planning process that includes identifying goals, prioritizing them, and presenting a plan (e.g., via a PowerPoint) to stakeholders.

Next steps / Suggested activity for study

• For a hypothetical student (Alex): identify at least six potential communication goals, categorize them as high/moderate/low, and prepare a brief outline for a PowerPoint to share with the team.
• Practice translating a clinical observation (e.g., missing function words in a sentence) into a concrete goal (e.g., “Alex will use conjunctions such as and, but, because in 4 of 5 opportunities in classroom discourse”).
• Reflect on how to collect data for progress toward each goal (e.g., frequency counts, example sentences, narrative samples, exit prompts).