“Nothing about us without us”* – what children with Developmental Language Disorder tell us about their relationships with peers – and what we should do in response

Research about children with Developmental Language Disorder (DLD) tells us that, compared to their typically developing peers:

• children with DLD have difficulties with peer relations and friendships (e.g. Lloyd-Esenkaya et al., 2020);
• adolescents with DLD are, on average, less popular and have lower quality friendships (e.g. Durkin & Conti-Ramsden, 2007; Fujiki et al., 1999); and
• children with DLD are at a higher relative risk of poor mental health outcomes (e.g. Conti-Ramsden & Botting, 2008; and Yew & Kearney, 2013).

But what do children and young adults with DLD say about their own experiences with peers? 

Blaskova and Gibson (2021) conducted a review and identified six types of studies that included input from children with DLD: interviews, socio-metric, self-report, task-based, naturalistic observation, and staged observation (see full citation below). 

Three key themes jumped out at us:

1. Friendships, play, and conversation and the social use of language

• Like most children, younger children with DLD want someone to play with and to talk with.
• Many children with DLD know that peers play a crucial role in daily experiences and quality of life; and that having friends makes school and life easier.
• Children with DLD report that it is less easy for them to make friends, compared with other children.
• Preschoolers without DLD make judgments about potential friends based, in part, on whether they play with them and talk with them.
• Children with DLD, on average, spend more time in solitary and onlooker play compared to peers.
• Children with DLD report that they do not know what to talk about with classmates who, in return, did not always include them in conversations.
• Some young children with DLD have difficulties grasping the nature of friendship, and judging whether someone is really their friend. 
• Children with DLD are worried about being accepted by others and being bullied. They self-report more bullying incidents than their peers do. 
• Some children with DLD say that true friends don’t focus on their language or speech differences, or help explain differences to others.
• Language and speech differences might play a smaller role in friendships as children grow older.
• For some children with DLD, friendship quality may be more important than the number of friends they have.

You can read more about the social use of language (also known as “pragmatic language”) here.

2. Inclusion

• For preschoolers, language differences can have a bigger effect on a child’s early social success than factors like age, race, gender, and socioeconomic status. However, other factors play a part, too.
• Many children with DLD report less contact with their peers than classmates who do not have DLD have with peers. 
• Some children with DLD feel singled out and different when they are pulled out of class to receive extra support.
• Spending more time together with peers may help peers to tolerate (get used to) the language differences of children with DLD. 

You can read more about different kinds of participation here.

3. Frustrations, behaviours, and particular language difficulties

• Some children with DLD find it annoying that they have to keep repeating themselves or have their speech corrected when talking with their friends.
• Many children with DLD do not easily understand the difficulties caused for listeners when children with DLD don’t provide enough information to make themselves understood.
• Some children with DLD report difficulties using language appropriately to negotiate and to manage conflicts with their peers.
• Understanding emotions, and emotion recognition abilities, may help to reduce feelings of victimisation for some children with DLD.
• Many children with DLD are not as skilled at attributing mental states to others (e.g. sadness, anger, fear), or recognising sarcasm, jokes, lies, pretending, or mixed emotions as their peers.
• Some children with DLD think they are not competent at academic tasks, and this is a big worry for them during the transition to high school. They are also worried about social abilities and their physical functioning.  

You can read more about the complex relationships between language and behaviour here.

Our takeaways: what we should do with this information

If we want to support children with DLD, we need to know what they need and want. One of the best ways to do this is to ask children with DLD about their lives, priorities and goals and include them as true partners in research about DLD, with shared decision-making. This may require creativity to overcome challenges created by language difficulties, e.g. using visuals, drawings and other supports to help children with DLD to communicate their requirements and preferences in detail.

Most children with DLD want to socialise. But many lack the language tools, opportunities, and experiences to succeed. As such:

• language therapy for children with DLD should target language structures and social use of language together. Structural language is a significant predictor of social use of language; and therapy targeting language structure helps children with difficulties using language in social settings (e.g. Norbury et al., 2017; Adams et al., 2012, 2015). (You can read much more about the form, content and use of oral language here); 
• we should work to increase the social participation of children with DLD, and to help children with DLD to engage more actively towards and in response to peers. This means:
  • working to ensure that children with DLD are included in activities with their peers (with or without support), rather than being pulled out and treated as special or different; and
  • increasing the opportunities for children with DLD to engage with peers, at school and in other places with other people. You can read more about participation-based approaches to supporting children with DLD and other communication disorders here. You can read specific suggestions to increase participation for:
    • preschoolers, here; 
    • 6-12 year olds, here;
    • 13-15 year olds, here; and
    • 16-18 year olds, here;
• in therapy, we should work on social inferencing, verbal reasoning, and background knowledge using ‘real world’ social scenarios, places and interests;
• we should work on language and the recognition and discussion of emotions together;
• we should support children at complex sentence and discourse levels – including with recounts, sequences, explanations, conversation, contextualised story analysis and story-telling, negotiation and conflict resolution. You can read more about discourse level work in the context of supporting teenagers here;
• we should work on higher level language skills, including similes, metaphors, idioms, homophones and homonyms, and analogies to help children to understand and use figurative language, including social idioms; and     
• we should support children’s strengths and abilities and respect their interests by targeting functional outcomes.

Finally, remember that families have an essential role to play in supporting children with DLD to fit in and to succeed socially.

Key source: Blaskova, L.J., and Gibson, J.L. (2021). Reviewing the link between language abilities and peer relations in children with developmental language disorder: The importance of children’s own perspectives. Autism & Developmental Language Impairments, 6, 1-18. (Any errors of interpretation or in our takeaways are our own.)

*For more about the history or this important phrase see this article. 

This article also appears in a recent issue of Banter Booster, our weekly round up of the best speech pathology ideas and practice tips for busy speech pathologists and speech pathology students.

Sign up to receive Banter Booster in your inbox each week:

Related articles:

• What is ‘pragmatic language’? The social use of language
• Not about ‘fixing’: using the ‘F-Word Framework’ to support children with communication disorders and their families
• Pragmatic language for 5-11 year-olds includes (at least) 27 observable behaviours
• Helping Children with Pragmatic (Social) Language Challenges. Some Evidence-based Themes
• Do language difficulties cause behavioural problems at school? (A 2022 research update)
• Speaking for themselves: why I choose ambitious syntax goals to help students put their words together (with research updates and resource links)
• Oral language comprehension: what is it? A plain English explainer
• Focusing speech therapy on functional outcomes: a refresher
• Help your child to fill in the gaps, join the dots, and read between the lines! (Improve inferencing skills for better reading and language comprehension)
• Why background knowledge about the world can increase reading comprehension – even for facts you can just Google (with 2021 research update and free resources to boost your child’s background knowledge)
• Five ways to boost your child’s oral language and reading comprehension skills with sequencing
• Friends are the key: Parents play an important role in helping children with Developmental Language Disorder to fit in