Published on March 14th, 20180
Developmental Language Disorder: Why You Should Add DLD to Your Vocabulary
By Alex Rice
Estimates suggest that about 7-10% of children at school entry have a language disorder of unknown cause (Norbury et al, 2016; Tomblin, 1997). In general, this corresponds to about two children in every classroom. Despite the high prevalence, there is poor public awareness about language disorders. While characteristics of autism spectrum disorder, attention deficit hyperactivity disorder and dyslexia have become common knowledge, most people still know very little, if anything, about language disorders in children.
So why is there such limited awareness of language disorders? While multiple factors play a role, terminology is a key obstacle to awareness efforts. Across Canada and internationally, the terms developmental language disorder (DLD), specific language impairment (SLI), language delay, language learning impairment and others are used almost interchangeably to describe the same language problems in children. The variety of terminology poses a challenge to raising awareness. Simply put, how do you raise awareness of a disorder that doesn’t have a consistent name?
A recent project called CATALISE assembled a panel of experts — including speech-language pathologists, psychologists and teachers — to come to a consensus on which label should be used to describe language problems in children. They used a systematic method called the Delphi survey technique to review the potential of each proposed term as a clinical diagnostic label. During this survey, advantages and disadvantages were identified for each potential name. The expert panel eventually reached the consensus that developmental language disorder (DLD) was the best option. Efforts such as the Raising Awareness of Developmental Language Disorders (RADLD) campaign in the UK have since embraced the use of DLD as a common terminology with the goal of accelerating awareness efforts.
For an in-depth explanation of the CATALISE project, please watch RADLD’s video Developmental Language Disorder (DLD): The Consensus Explained.
The goal of the RADLD campaign was to promote the use of developmental language disorder (DLD) as the universal name for language disorders in children. A common terminology for language disorders is long overdue and will benefit clients in numerous ways. In practice, however, convincing an entire profession to change its terminology is not an easy task. With DLD being new to many clinicians, some may have concerns or confusion about its merits over other labels. This next section addresses some concerns clinicians may have about incorporating DLD into their professional vocabulary.
1) What exactly is the definition of DLD? Is it the same as SLI?
Developmental language disorder (DLD) is a new label intended to replace the terms specific language impairment (SLI), language learning impairment and language delay. Experts on the CATALISE panel defined DLD as language problems that create obstacles to communication or learning in everyday life. To be considered a DLD these problems must be unlikely to resolve on their own and they must not be associated with a known biomedical condition (Bishop et al, 2017). If a child’s language disorder is associated with a known biomedical condition, the label “language disorder associated with [name of condition]” is used instead.
2) Why is there so much emphasis on assigning labels to children?
The merits of labelling have been debated at length among professionals. In the fields of mental health and disability, many professionals worry that labelling will lead to stigmatization and low self-esteem. Despite these concerns, the use of labels is now common practice. In some cases, a label is required for a client to access resources and support.
Positive outcomes of labelling include improved communication among professionals and increased awareness among the general public. It has also been suggested that labels can positively affect self-esteem and reduce stigma in some cases (Lauchlan & Boyle, 2007). Many clients are relieved to receive a label because it explains the difficulties they have been experiencing. The presence of a label also helps teachers and peers understand a child’s behaviour, which can contribute to acceptance of the child in the classroom.
3) Why choose to call it a “disorder”?
In the CATALISE project, members of the panel expressed concern with the word “disorder” because they felt it was associated with a negative stigma. However, others argued that words like impairment or delay don’t capture the seriousness of the disorder. When discussing language disorders, we must be careful to not imply that the child might simply grow out of the disorder, or that it is no big deal. Research shows that children with DLD are unlikely to grow out of their difficulties without intervention (Stothard et al, 1998).
The word “disorder” has the benefit of being consistent with other neurodevelopmental diagnoses like autism spectrum disorder and attention deficit hyperactivity disorder. It is also compatible with the DSM-5 term language disorder and with planned terminology for the International Classification of Diseases (ICD) 11. Being consistent with these well-established classifications systems will emphasize the importance of DLD as a term and improve communication among professionals.
The term developmental language disorder (DLD) was selected following extensive discussion among a team of professionals. Although there may be drawbacks to using the word “disorder,” the benefits of including the word were ultimately thought to outweigh these drawbacks. It is also important to note that throughout the CATALISE discussions, there was no term that was deemed to be perfect (Bishop et al, 2017). During the discussions, members of the panel brought forward criticisms for each of the proposed terms. In conclusion, DLD may not be the perfect term, but it is the best option we have.
The lack of public awareness of the term developmental language disorder (DLD) is a problem. Poor awareness means children with DLD have a lower likelihood of being identified early, have less community supports available to them, and receive less attention and funding in the research world. With the CATALISE project’s well-reasoned choice of DLD as the new term, we have an exciting opportunity to establish a universally-recognized name for language disorders. Having a unified terminology will help the public understand DLD and connect clients to the support they need. Going forward, efforts must continue to inform clinicians of DLD and encourage them to incorporate it into their vocabulary. Now is our chance to collaborate using a common language to get the word out about DLD!
To help explain the DLD terminology to friends, colleagues, and clients, be sure to share RADLD’s video DLD 1-2-3!
Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T., and the CATALISE‐2 consortium, Adams, C., House, A. (2017). Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 58(10), 1068–1080.
Ebbels, S. (n.d.). International consensus on diagnosis for children with problems with language development. Retrieved from http://naplic.org.uk/sites/default/files/Summary%20of%20CATALISE%20%28v3%29.pdf
Lauchlan, F., & Boyle, C. (2007). Is the use of labels in special education helpful? Support for Learning, 22(1), 36–42.
Norbury, C. F., Gooch, D., Wray, C., Baird, G., Charman, T., Simonoff, E., … Pickles, A. (2016). The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 57(11), 1247–1257.
Tomblin, J.B., Records, N.L., Buckwalter, P., Zhang, X., Smith, E., & O’Brien, M. (1997). Prevalence of speciﬁc language impairment in kindergarten children. Journal of Speech and Hearing Research, 40, 1245–1260.
Stothard, S.E., Snowling, M.J., Bishop, D.V.M., Chipchase, B.B., & Kaplan, C.A. (1998). Language-impaired preschoolers a follow-up into adolescence. Journal of Speech, Language, and Hearing Research, 41, 407–418.
Alex Rice is a graduate student in her final year of the Speech-Language Pathology program at Western University. Prior to her studies at Western, Alex completed a Bachelor of Science degree at McMaster University, majoring in Biology and Psychology. She also currently volunteers as a Western Student Council representative for SAC and OSLA.
This blog post was completed under the guidance of Dr. Lisa Archibald and was submitted as a final project in the Developmental Language Disorders 2 graduate course in the speech-language pathology program at Western University. You can view more final projects for this course at http://www.uwo.ca/fhs/lwm/teaching/dld2.html and learn more about the course by following #WesternDLD2 and @larchiba6 on twitter.