Developmental language disorder (DLD) is a brain-based condition that affects around two children in every primary school.
Diagnosis is important because if untreated this condition can lead to severe difficulties later in life, says speech and language therapist Christian Wright.
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Kids with DLD have difficulty both expressing themselves and understanding others, Wright tells Nine to Noon.
They may make speech sounds that are unclear, but this isn't necessary for a diagnosis.
"Certainly it’s a language-based issue. It’s not associated with other known conditions like autism, hearing loss, cerebral palsy, Down syndrome. Children who have language issues with those conditions, we would just say that they have a concomitant language issue, but it's very much a condition that stands alone.
“So your hearing is fine. Typically, their cognition is quite good. But they have these language difficulties and it's a lifelong condition. It's often discovered in childhood and that's often where we'd like to start treating it. But it persists for many into the adult years and these are the children who have these language difficulties as pre-schoolers."
If a child's self-expression and understanding is impaired when they start school, they begin with language levels significantly lower than their peers, Wright says.
“It's often characterised by spoken language difficulties like limited vocabulary, poor grammatical development. Like a boy I was working with the other day who's almost five. Instead of saying ‘that boy is riding his bike really fast' he said to me, ‘him doing bike’. [Children with this condition] completely truncate the sentence and oversimplify the language.”
Difficulties with understanding seem to go along with poor working memory, he says.
If we imagine working memory as a series of slots that we can put information into temporarily, these children have a significantly restricted number of slots.
“So, if it were like a window, it's a tiny window through which you have to push information because they keep losing a lot of what they're understanding.”
Wright says it is not known why some children have this condition and some don't, but there is a suggestion that it may run in families.
“It looks like there's some kind of combined impact of inherited genes, rather than a specific mutation.
Premature birth, low birth weight and a lack of oxygen at birth may increase a child's risk of developmental language disorder, Wright says.
“It’s across a range of issues and… it's not something that a parent can control.”
Getting a diagnosis is vital because if the condition isn’t treated there will be profound consequences.
“In terms of impact, our research shows that these are the kids who are six times more likely to have issues with spelling, reading, and anxiety. They're four times more likely to have issues with maths, boys getting into negative cycles of behaviour, three to four times more likely that they'll suffer depression, girls encounter sexual abuse, and this comes from some research, which was done between 2004 and 2009.
“And also for adults, they're two times more likely to go over a year without employment… We think a significant proportion of the prison population have developmental language disorder.”
There are some signs to look out for in young children, particularly pre-schoolers who are late talkers and have less than 20 words by 18 months old.
“They have limited babbling, the gestural development is pretty absent, so they're not shaking their head for no or waving by or pointing.
“We also found 90 percent of the children who had DLD had a lack of word combinations at 24 months and a family history of speech and language issues.”
Parents may themselves have had developmental language disorder and passed it on unintentionally.
Treatment will depend on the severity of the child's diagnosis, because DLD, like any condition, is on a continuum, Wright says.
“The treatment can vary from sound therapy, alongside developing comprehension skills.
For teachers and parents, he has some recommendations:
"Reduce the length and complexity of your instructions - that gives the child a chance to understand what you might be saying and give them time to process what you've said.
“Think about the number of questions you ask versus the comments you make. So the more questions you ask, you often get no response.”
Wright says he often reduces the complexity of his questions down so they require only a yes or no answer. You can also offer the child possible answers.
Teaching them how to use the word ‘because’ is very important.
“It's quite complicated teaching ‘because’ to a child, but a very critical skill because it develops a person's ability to inference and inference is where you collect clues from the environment to understand what's going on.
“And for children with developmental language disorder, they often come across as naive or they get into trouble because they have trouble inferencing.
"And these are the kids as teenagers, they get into the wrong crowd and can't put things together very well. And all of a sudden, the police are knocking on your door. And they don't understand why this is an issue. They haven't really kind of put it together, the consequences escape them.
“[These children] have to be taught explicitly some of the things that we've just picked up implicitly by existing in the environment and listening to our parents talk. Often when I meet children, if a child has a comprehension difficulty, it immediately makes everything else more complex.
“Not every child presents with a comprehension difficulty. Some children come in, specifically with an expressive language difficulty, and their comprehension is quite intact. And there's a whole host of reasons for that. But the children with comprehension difficulties tend to be the ones that struggle throughout their schooling career.”