Banter Speech & Language

Sydney speech pathologists helping adults and children speak for themselves.

developmental language disorder

Light Up Language With Idioms

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In this video blog, we discuss idioms: why they are important for primary and high school students (including children with developmental language disorders), which idioms to learn, and how to teach them.

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond.

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What I think about when I meet a child who can’t read

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Too many students have significant reading comprehension problems. When working with a struggling reader, you need an evidence-based plan. 

But, before you can plan, you need to know what you’re looking for, and why. In this short video-blog, we outline the key mental models we apply when assessing students with reading difficulties.

We hope you find it useful! 

Our free eBook: Reading Problems and what to do about them

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Concord West, North Strathfield, Rhodes, and Strathfield, and all other suburbs of Sydney.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee.

Dyslexia vs Developmental Language Disorder: same or different, and what do we need to know about their relationship?

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Dyslexia is a language-based disorder. But so is Developmental Language Disorder (DLD). Are they the same thing?

Tricky question – and one that comes up a lot in my clinic when I’m working with struggling school-aged students.

Luckily, much bigger brains than mine – including Professors Suzanne Adlof and Tiffany Hogan – have been looking at this question. This line of research has helped inform our approach to assessing and treating children with dyslexia, DLD, and both dyslexia and DLD.

We thought it would be useful to summarise some of our key takeaways to help others who may be thinking about the relationship between dyslexia and DLD.

1. But first, some difficult definitions

The definition of dyslexia is controversial. Despite attempts to reach consensus, there is also no universally accepted definition of DLD.

Definitional issues get in the way of research, knowledge translation and advocacy. Without minimising the academic importance of such debates, parents, front line educators and health professionals, and others working with children with dyslexia and/or DLD need to understand the recent research so they can seek/deliver the best outcomes. So, for this article only:

“dyslexia” means:

  • severe difficulty learning how to read; despite
  • normal vision; and
  • adequate reading instruction; and
  • adequate cognitive abilities (i.e. no intellectual disability) (e.g. Lyon et al., 2003); and

“DLD” means an unexpected deficit in language abilities despite adequate environmental stimulation and cognitive abilities with no neurological impairments (e.g. Bishop et al., 2017).

2. Parallels

Clearly, there are some parallels. Both dyslexia and DLD:

  • are language-based disorders; 
  • are deficits that are “unexpected” given the absence of intellectual disabilities or other medical explanations; and
  • require the child to have received adequate environmental stimulation: appropriate reading instruction for dyslexia, and adequate human language interactions for DLD. 

3. So what’s the difference?

(a) Phonological deficits vs. multi-dimensional language deficits: 

In dyslexia, the principal deficit is word reading. Most definitions of dyslexia include marked difficulties with word reading, decoding, and spelling. Many descriptions focus on phonological deficits as a core feature of dyslexia (e.g. Moats, 2008). 

Phonology is the system of contrastive relationships among the speech sounds that constitute the fundamental components of a language. Phonological deficits impact the specificity at which sounds are stored and recalled in words, as well as the reader’s ability to manipulate sounds in words and connect sounds to letters to read words. Lots of evidence shows that children with dyslexia, on average, perform poorly on tasks that involve phonology, including phonological awareness, word and nonword repetition, and word retrieval (e.g. Vellutino, et al., 2004).

In DLD, children may have language deficits across multiple dimensions of language. These can include phonology. But they can also affect vocabulary, semantic knowledge, morphology, syntax, and the social use of language: the so-called content, form and use of language. 

(b) Biologically primary v. secondary knowledge

Oral language is biologically primary knowledge – humans as a species have a natural instinct for it. Reading words is biologically secondary – or unnatural. In evolutionary terms, decoding written words is a recent development and everyone has learn how to do it. (Incidentally, that’s one reason why many definitions of dyslexia (controversially) exclude reading problems caused by poor instruction. Otherwise, everyone who was illiterate would be dyslexic, which is not the case.)

4. But don’t forget the Simple View of Reading!

There is an important – if confusing – overlap of concepts when it comes to reading. Being a good reader means more than only reading the words on the page – you need to understand what you are reading, too. Reading comprehension is the product of accurate and efficient word reading and language comprehension. So when assessing people with reading problems, education and health professionals need to look at both decoding skills (which may be relevant to a diagnosis of reading difficulties or dyslexia), as well as general language comprehension skills (which may be relevant to a diagnosis of DLD). 

Many reading comprehension skills are based on biologically primary oral language or other knowledge. Oral language comprehension skills, phonological awareness, vocabulary and naming skills, theory of mind, knowledge of human relationships, knowledge of biology (notably animals and plants), and physical environments – as well as background knowledge about the world – contribute to helping kids understand what they read.

The key point is that good reading comprehension requires good decoding skills and good language comprehension skills; and that deficits in either (or both) can cause clinically significant reading problems. In other words, children with dyslexia and many children with DLD have reading problems. But reading problems can be caused by decoding problems, language comprehension problems or both – and it is essential to find out which deficits are contributing to a child’s difficulty reading so that you can plan the right intervention.

(You can read more about the so-called “Simple View of Reading” here. You can read more about biologically primary and secondary knowledge here.)

5. So, if dyslexia is a language based disorder, do all children with dyslexia have DLD? Will all children with DLD be dyslexic?

The short answer appears to be “no” and “no”. Although the science is not yet settled, DLD and dyslexia appear to be distinct disorders that can co-occur. 

Catts et al., 2005, for example suggests that:

  • the majority of children with DLD do not have dyslexia; and
  • the majority of children with dyslexia do not have DLD; and
  • phonological deficits are more closely related to dyslexia than DLD.

This research supports the so-called “fully distinct hypothesis”, which can be depicted as follows:

(Picture credit: Adlof & Hogan, 2018 – see full citation below)

Current evidence also suggests:

  • dyslexia and DLD frequently co-occur, although no one knows exactly how often (different studies, with different designs, show a 17-71% co-occurrence!);
  • some children with dyslexia who do not have DLD still present with relatively weak language skills compared with typically developing peers, e.g. with poorer vocabulary, sentence repetition, and syntax comprehension skills, that are still within the normal range (e.g. Bishop et al., 2009);
  • some children with dyslexia present with normal or even above-average oral language skills (e.g. Alt et al., 2017; De Groot et al., 2015); and
  • some children with dyslexia but normal oral language skills (i.e. no DLD) show poor word learning compared to typically developing children, especially when it comes to learning the phonology of new words (e.g. Alt et al., 2017).

6. What do we do with this research? Our clinical takeaways

This research has had – and continues to have – a big impact on our clinical practice. Our key takeaways are as follows:

  • Everyone working in child literacy – parents, researchers, speech pathologists, teachers, educational psychologists, and students themselves – need to know that dyslexia and DLD are distinct but often co-occurring disorders.
  • It is likely that at least half of the children identified with reading difficulties in schools will have co-occurring (but perhaps undiagnosed) DLD (e.g. G.M. McArthur et al., 2000).
  • Many children with dyslexia who perform within normal limits on standardised language tests may still have significant (if sub-clinical) language difficulties that may warrant monitoring and accommodations.
  • Students with dyslexia – regardless of whether they also have DLD – are at risk of slower language acquisition and slower growth of world knowledge across their lifetime because of reduced reading experience – the so-called Matthew Effect. In addition to high quality, evidence-based reading instruction, these students may benefit from compensatory techniques that build their exposure to great books/texts and increase knowledge about the world other than through print, e.g. through audiobooks or video recordings of school texts (e.g. Milani et al., 2010).
  • When assessing school-aged children with reading difficulties, it is essential that the assessment battery include both reading and oral language assessment tasks including tests of phonology, orthography (spelling), morphology, semantics, vocabulary, syntax and discourse processing. 
  • Regardless of the label (or labels), intervention needs to be tailored to target each child’s strengths and weaknesses across all domains of language, in part because they all impact reading comprehension. 
  • Teachers, speech pathologists, psychologists, reading specialists and special educators need to collaborate to help support students with multiple needs. We also need to educate each other – to share our knowledge and avoid inconsistent jargon – to address reading and oral language issues for students under our care.

Principal source: Adlof, S. M., and Hogan, T.P. (2018). Understanding Dyslexia in the Context of Developmental Language Disorders, Language, Speech, and Hearing Services in Schools, 49, 762-773.

For more information about DLD, see, follow and support the wonderful work of Raising Awareness of Developmental Language Disorder. 

Related articles:

Image: https://tinyurl.com/y4wf5de6

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Concord West, North Strathfield, Rhodes, and Strathfield, and all other suburbs of Sydney.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee.

Banter Evidence Snapshot: Developmental Language Disorder and ADHD – 10 things to know

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To read our full article, check out: “She doesn’t really have a language problem. She just wasn’t paying attention to your tests.” FAQ: ADHD and language disorders

For other Banter Evidence Snapshots, see here.

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Concord West, North Strathfield, Rhodes, and Strathfield, and all other suburbs of Sydney.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee.

Does my child have a language disorder? 6 questions speech pathologists should ask before assessment

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From time to time, I get complaints about the length of my pre-assessment case history form. But I’m not shortening it.

Every question in my case history form has a purpose. Yet the answers to some questions are more important than others. When I get a case history form from the worried parents of a child, there are six key areas I zero in on as I prepare for the assessment.

Here’s why:

With language disorders, early help is the best help, so we need to know the most important risk factors/predictors. 

  • About 7.5% of kindergarten-age kids – 1 to 2 in every class – have developmental language disorders (Tomblin et al., 1997).
  • The earlier kids with language disorders can get help, the better (e.g. Guralnick, 2011); and early intervention is generally seen as the most effective intervention (e.g. Olswang et al., 1998).
  • It’s never too late to get help for a language disorder. But, in the best of worlds, we want to find and start helping kids at risk during their toddler years. Unfortunately – as yet – there is no blood test or brain scan we can administer to know for sure whether a toddler has a developmental language disorder.

So, before a child comes in to see me for the first time, I examine the case history form filled in by the family and look carefully at these six risk factors:

Key risk factor 1: late talking as a key risk factor and predictor of language disorders

  • One thing speech pathologists watch out for are early signs and symptoms of language disorders, especially limited babbling, limited gestures or late talking (Hagan et al., 2008). In particular, a lack of word combinations at 24 months is a significant predictor of language impairment (Rudolph & Leonard, 2016).
  • But:
    • a lack of word combinations at 24 months only identifies about half of kids with developmental language disorders (Rudolph & Leonard, 2016);
    • many late talkers spontaneously recover by early school years, meaning they never had a developmental language disorder (e.g. Ellis Weismer, 2002); and
    • early language performance alone is not enough to identify kids who will go on to have chronic difficulties with language (Dollaghan, 2013; Leonard, 2013).
  • To make things more complicated, some kids hit or exceed their early language milestones, but still go on to have developmental language disorders as preschoolers or school-aged kids (e.g. Poll & Miller, 2013).
  • So:
    • just because your child is a late talker, doesn’t mean he/she has a developmental language disorder; and
    • even if your child is a late talker, he/she might still have an undetected language disorder.
  • In other words, late talking alone isn’t enough to predict which toddlers will have significant and chronic language disorders. We need additional ways of spotting kids at risk.

Key risk factors 2-5: Which risk factors are as clinically significant as late talking?

Great question. And one researcher, Johanna Rudolph of the University of Texas at Dallas, has looked at in detail recently. She performed a systemic review and meta-analysis of peer-reviewed articles on risk factors. (This is the highest level of evidence, albeit subject to the strengths and weaknesses of the studies reviewed.)

Dr Rudolph identified 11 risk factors that were statistically significant predictors of developmental language disorders. Of these, four were equally or more predictive than late talking:

  • children of mothers who did not finish high school;
  • children with older siblings;
  • boys (!); and
  • children who scored ‘very low’ on their 5-minute Apgar test (named after Dr Apgar in the 1950s, but also referred to by the “backronym”*: Appearance, Pulse, Grimace, Activity, and Respiration).

Key risk factor 6: Family history of reading, language or other communication disorders

Most speech pathology researchers think there is a strong genetic element in developmental communication disorders, including language disorders. Language and reading problems tend to run in families.

For example, Rudolph and Leonard (2016) found that a lack of word combinations at 24 months combined with a family history of communication disorders resulted in the identification of almost 90% of children with developmental language disorders. This was significantly more than were identified by late talking alone.

Clinical bottom line: be aware of the key risk factors, but don’t panic!

If your child is or was a late talker, or falls into one or more of the other clinical risk categories, don’t panic! After all, just under 50% of population have at least one of the risk factors – being male (including me)!

Having one or more of these risk factors doesn’t mean that your child has a language disorder. But, as a parent, I’d rather know if my child is at a heightened risk. A discussion of risk factors is always scary, and I sincerely hope that this article doesn’t alarm anyone. The purpose of this article is not to alarm, but to inform. And, if knowledge of key risk factors increases the chance that children at risk are spotted early, assessed and (if warranted) helped, then this article has done its job!

Related articles:

Principal source: Rudolph, J.M. (2017). Case History Risk Factors for Specific Language Impairment: A Systematic Review and Meta-Analysis. American Journal of Speech-Language Pathology, 26, 991-1010.

For further, less specific, reading about risk factors, see our earlier article here.

*As a morphology nerd, I love the term “backronym”, a noun meaning “an acronym deliberately formed from a phrase whose initial letters spell out a particular word or words, either to create a memorable name or as a fanciful explanation of a word’s origin.”

Image: http://tinyurl.com/yakmvrcl

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Concord West, North Strathfield, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).

Your right to know: long-term social effects of language disorders

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We speech pathologists need to talk more about some of the long-term, negative effects of developmental language disorders. We need to explain why getting help is so important. And not just for late talking toddlers and pre-schoolers. School-age children, older children, teens and young adults, too.

One reason I think we don’t talk about long-term problems – despite knowing about most of then for over 20 years – is that we don’t want to worry parents and carers. But they have a right to know this stuff, even if it’s hard to talk about.

So here’s what some of the peer-reviewed clinical research tells us:

1. Language disorders don’t disappear when a child goes to school

  • Developmental language disorders:
    • are often not picked up in children (Cohen et al., 1998);
    • often cause peers and others to respond negatively to the affected child (Redmond & Rice, 1998);
    • can cause a child to be perceived by parents, teachers and other students as exhibiting challenging behaviours and/or emotional problems (e.g. Benner et al., 2002);
    • have a high persistence rate into adolescence, particularly for comprehension of language (e.g. Clegg et al., 2005); and
    • typically persist into adulthood (e.g. Johnson et al., 1999).

2. Language disorders affect social participation  

  • Compared with typically developing kids, children with developmental language disorders, on average:
    • have fewer friends, poorer quality friendships and participate less in social activities (e.g. Durkin & Conti-Ramsden, 2007);
    • are more likely to show social difficulties, including social withdrawal and difficulties joining groups of peers (e.g. Hart et al., 2004; Mok et al., 2014);
    • converse less;
    • have difficulty persuading others; and
    • respond less sensitively to peer communications (e.g. Brinton et al., 1998; Vallance et al., 1999).
  • Children and young adults with developmental language disorders:
    • may withdraw socially in response to the effects of their disorder (which includes difficulty talking with others and being rejected by peers) (e.g. Hoff, 2006; Redmond, 2011);
    • report higher levels of anxiety and are diagnosed with anxiety disorders more frequently than typically developing peers (e.g. Beitchman et al., 2001; Maggio et al., 2014); and
    • may have deficits in social skills (e.g. Botting & Conti-Ramsden, 2008).

3. Language disorders are associated with heightened risks of social anxiety

  • There is some evidence that teens with developmental language disorders have higher rates of anxiety related to social interaction and avoidance of social situations than typically developing peers (Wadman et al., 2011).
  • New evidence from long-term studies suggests that young children diagnosed with developmental language disorders have higher rates of social phobia at ages 19 and report higher levels of social interaction anxiety symptoms at age 31. Despite some limitations in these studies (such as high drop-out rates), social anxiety symptoms tended to persist into adulthood, although not to the degree warranting a formal diagnosis of social anxiety disorder. In particular, young adults with a history of language disorders reported difficulties talking to others and asserting their perspectives (e.g. Brownlie et al., 2016).

4. Language disorders affect academic and work outcomes

  • Children’s capacities at school entry are predictive of academic outcomes (e.g. Snow, 2006).
  • Early success at school is a strong indicator of ongoing and future success (e.g. Prior et al., 1993).
  • Teenagers with language disorders are at risk of poor academic progress, bullying and behavioural problems, like acting out in class (e.g. Snow & Powell, 2004).
  • Lots of teenagers with language problems give up, drop out and end up in unskilled, poorly paid jobs. And teenagers with language disorders are well over-represented in the youth justice system.
  • The negative effects of developmental language disorders are arguably growing, rather than dissipating:

Clinical bottom line

For many teens and young adults, language disorders are “invisible disabilities” (Beitchman & Browlie, 2014). Having a language disorder can have big, long-term negative effects on your school, work and social participation across the lifespan. Older children and young adults affected by language disorders need to know this and get the help they need to stay engaged at school and work, and to have rewarding social lives.

Educating parents and carers of younger children with developmental language delays upfront about the longer-term issues their children may face is an important part of being a responsible speech pathologist. Even if the information is sometimes hard to discuss.

Principal source: Browlie, E.B., Bao, L., & Beitchman, J. (2016) Childhood Language Disorder and Social Anxiety in Early Adulthood. Journal of Abnormal Psychology, 44, 1061-1070.

Image: http://tinyurl.com/z7ncjk4

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).