Teens with DLD

Teenagers with DLD are at risk for peer problems, anxiety and depression but we don’t know why

David Kinnane · 25 April 2021 ·

Developmental Language Disorder (DLD) affects 7-8% of the population, and is a difficulty with receptive and/or expressive language that cannot be accounted for by any other neurotypical disorders, hearing impairments or global intellectual difficulties.

You can read more about DLD, its effects, and treatments here in our DLD Guide for Families.

Compared with their typically developing peers, teenagers with DLD are at risk for:

peer problems;
anxiety; and
depression.

We don’t know why.

Language is integral to social functioning, affecting the quality of friendships and participation in many social activities.

Teachers, on average, rate children with DLD as more withdrawn than typically developing classmates.

Many children with DLD struggle to initiate and to maintain conversations with peers, and have difficulties with conflict resolution and hiding emotions to protect others’ feelings.

Children with DLD experience higher rates of victimisation compared with their typically developing peers.

Some (but not all) teenagers with DLD report higher feelings of social stress and social phobia.

Parents of teenagers with DLD perceive that their children experience significantly higher rates of peer problems compared to typically developing children.

Difficulties interacting with others may explain over half the variance in emotional problems experienced by teens with DLD.

Interestingly, teenagers with DLD did not report significantly higher peer and emotional problems compared with their typically developing peers.

The gap between parent and teenager perceptions of social difficulties may be because some teenagers with DLD are less aware of their social difficulties due to the effects of DLD. There may be other explanations, though, and we don’t yet know for sure.

For an accessible version of our infographic, watch our video:

Source: Forrest, C.L., Gibson, J.L., & St Clair, M.C. (2021). Social Functioning as a Mediator between Developmental Language Disorder (DLD) and Emotional Problems in Adolescents. International Journal of Environmental Research and Public Health, 18, 1221.

Related articles:

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, both in our clinic and via telehealth.

Worried about the HSC? 8 practical (and free) things you can do this week to get ready

David Kinnane · 15 January 2020 · Leave a Comment

For young adults doing the HSC, 2020 might seem daunting. So much information to absorb, with so little time!

And spare a thought for students with language disorders, reading problems and other learning difficulties. Many overwhelmed students don’t know where to start.

Fear not!

To help our clients and readers, we’ve been talking to recent HSC graduates and their parents about useful tips to cope and thrive. Here are our top 8 to date: all free and easy to implement in a couple of hours!

1. Make up a single “HSC Master Folder”: Get a lever arch file and label it: “HSC Master Folder”. Put coloured tabs in it – one for each subject you are studying.

2. Assign a coloured tab to each subject: For example, you might assign blue to Advanced English and orange to Mathematics. Use the colours to sort out all your notes/materials. For instance, keep all your English notes in blue folders, and your Maths notes in orange folders.

3. To understand HSC assignment and exam questions so you can answer them properly, learn (and review) the key exam words that appear frequently in HSC exams across multiple subjects.

Need a list of words to learn? Here you go:

Word	Meaning
Account	Account for: state reasons for, report on. Give an account of: narrate a series of events or transactions
Analyse	Identify components and the relationship between them; draw out and relate implications
Apply	Use, utilise, employ in a particular situation
Appreciate	Make a judgement about the value of
Assess	Make a judgement of value, quality, outcomes, results or size
Calculate	Ascertain/determine from given facts, figures or information
Clarify	Make clear or plain
Classify	Arrange or include in classes/categories
Compare	Show how things are similar or different
Construct	Make; build; put together items or arguments
Contrast	Show how things are different or opposite
Critically (analyse/evaluate)	Add a degree or level of accuracy depth, knowledge and understanding, logic, questioning, reflection and quality to (analyse/evaluate)
Deduce	Draw conclusions
Define	State meaning and identify essential qualities
Demonstrate	Show by example
Describe	Provide characteristics and features
Discuss	Identify issues and provide points for and/or against
Distinguish	Recognise or note/indicate as being distinct or different from; to note differences between
Evaluate	Make a judgement based on criteria; determine the value of
Examine	Inquire into
Explain	Relate cause and effect; make the relationships between things evident; provide why and/or how
Extract	Choose relevant and/or appropriate details
Extrapolate	Infer from what is known
Identify	Recognise and name
Interpret	Draw meaning from
Investigate	Plan, inquire into and draw conclusions about
Justify	Support an argument or conclusion
Outline	Sketch in general terms; indicate the main features of
Predict	Suggest what may happen based on available information
Propose	Put forward (for example a point of view, idea, argument, suggestion) for consideration or action
Recall	Present remembered ideas, facts or experiences
Recommend	Provide reasons in favour
Recount	Retell a series of events
Summarise	Express, concisely, the relevant details
Synthesise	Putting together various elements to make a whole

Source: NSW Education Standards Authority, A Glossary of Key Words

Most of these words are verbs and so-called “Tier-2” academic words – words that crop up across different subjects. Knowing these words is a huge help when reading school texts and answering essay and exam questions for most subjects.

4. Spend an hour (or two) learning about effective study techniques so you don’t waste time learning inefficiently:

(a) Read our article about free effective study techniques.

(b) Watch this short (8 minutes) YouTube video for 6 research-backed ways to study better.

(c) Go to the terrific Learning Scientists website for more details on each of these 6 strategies (including free downloads).

(d) Read HSC study guides, such as the ones available from The Sydney Morning Herald and the NSW Education Standard Authority (NESA).

5. Download a copy of the syllabus for each subject you are studying. For students in New South Wales, you can download each syllabus from NESA here.

6. For each syllabus you’ve downloaded, print the content and objectives/outcomes sections and put them in your HSC Master Folder. These tell you what you are expected to know for assignments and the exam.

7. Download and print the most recent available past exam papers for each subject you are studying, then put them behind the syllabus in your HSC Master Folder. (As we note here, doing practice exam papers is one of the best, evidence-based ways to improve your learning (and exam results)). It’s also a great way for you to practice remembering things under time constraints. You can access past NSW HSC exam papers from NESA here.

8. Most importantly, stay healthy – exercise, sleep and eat well, and keep things in perspective.

We hope you find these tips useful. As 2020 rolls on, we plan to add more tips.

Good luck!

Related resources:

Related articles:

Image: https://tinyurl.com/qat2qrz

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

10 great words to teach young high-schoolers (and why) – with brilliant free resources!

David Kinnane · 13 January 2018 · 2 Comments

Welcome to 2018, dear readers!

Over the last years, we’ve published hundreds of free articles, and ebooks summarising some of the latest research about speech, language, reading, stuttering, accent management and voice. You can access them all, anytime, on our new website.

This year, we’re committed to bringing you more free, Plain English, evidence-based information. But, this year, we’re going for something different.

Based on reader feedback, you’ll see fewer long articles covering theoretical academic debates in minute detail. You’ll see more short, sharp articles summarising practical strategies and tips you can implement at home, at school, or in your clinic.

So let’s get started!

Based on the terrific work of Dr Sarah Spencer and colleagues, here are 10 words we should teach young high-schoolers (12-14 year olds) and older children with language or reading difficulties.

1. Which words should you teach?

Interpret
Evaluate
Exclude
Sustain
Discriminate
Infer
Contribute
Generate
Summarise
Consult

2. Why these words?

All these words are:

cross-curriculum words. In other words, they are used in high school across multiple subjects. Cross-curriculum words are also known as “academic words” or “tier 2 words”. You can read more about these words, find out why they are so useful, and access longer words lists and other free resources here;
highly functional. They can be used in all sorts of places, with all sorts of people in the “real world”; and
verbs. Verbs are harder to learn than nouns, especially for children with language, learning or reading difficulties (e.g. Nash & Snowling, 2006).

To date, vocabulary interventions show that you can teach kids new words with lots of effort. But choosing the right words is really important because:

it takes lots of work for a child to learn a new word, especially if the child has language, learning or reading difficulties; and
learning a word doesn’t seem to automatically help a child learn other words (e.g. Snow et al., 2009).

3. How should the 10 words be taught?

Intensively: at least an hour a week, with home exercises between sessions.
Teach one word at a time, e.g. spend a teaching session talking only about “consult”.
Define the word explicitly (you can teach children to use a dictionary at the same time), e.g. “consult means to seek information or advice from, or to seek permission or approval from”.
Use lots of repetition, in lots of different contexts, e.g. you can consult a rulebook, the teacher, a school counselor, the principal, an umpire, a dictionary, Ikea instructions, a doctor, a lawyer, a teacher, a psychologist, a speech pathologist, an accountant, a weatherman/woman, a psychic (although not recommended!), Centrelink, the Department of Housing, a website, etc.
Teach to small groups (3-5 children) so they can work together and discuss the words based on their real world experiences.
Give children lots of opportunities to use the word in different ways.
Focus on different aspects of the word including the:
- meaning of the word;
- speech sounds and syllables that make up the word /kənsʌlt/, rhyming words (e.g. cult, adult, result);
- grammatical role of the word, e.g. “consult is a verb” – it’s something you do;
- morphology of the word, including the word origin (Latin meaning “take counsel”), its prefix (“con” meaning “with”) and root (“sult”, meaning to leap upon), as well as different word forms, e.g. consult, consults, consulted, consulting, consultant, consultation; and
- spelling of the word (c-o-n-s-u-l-t).
Use activities the kids like to increase motivation and engagement (e.g. by consulting “experts” on YouTube or Reddit).
Act out the word (there is some evidence that miming an action while saying the word can help younger children to learn verbs e.g. Riches et al., 2005).
Give the kids personal challenges at the end of the session where they have to use and act out the word at home or out and about.

Final tip: when teaching kids new words, go for depth of word knowledge, rather than breadth.

4. Where can you find free resources to teach these words to young high-schoolers?

For more information and resources (including free lesson plans!), go to this wonderful, evidence-based website run by Dr Spencer, a Lecturer and Speech and Language Therapist at the Department for Human Communication Sciences, at the University of Sheffield, United Kingdom. Free lesson plans and resources for each of these 10 words can be found here.

5. How can you assess whether your high-schooler has learned the words properly?

Check out Dr Spencer’s Word Knowledge Profile here.

Clinical bottom line

Young teenagers at risk of school failure often have poor knowledge of cross-curriculum words like the 10 listed above. Knowing cross-curriculum words can be a big help at school and in life. We should teach cross-curriculum words to teenagers, especially those at risk of school failure. Thanks to the wonderful research and resources provided by Dr Spencer and her colleagues, we’re well equipped to teach at least 10 of these words.

Principal source: Spencer, S., Clegg, J., Lowe, H., Stackhouse, J. (2017). Increasing adolescents’ depth of understanding of cross-curriculum words: an intervention study. International Journal or Language and Communication Disorders, 52(5), 652-668. Abstract link: http://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12309/abstract

Further reading and free resources:

Image: https://tinyurl.com/ybaufb2o

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

“I’m not a child!” How to get help for a teenager or adult you love who can’t read

David Kinnane · 24 April 2017 · Leave a Comment

Imagine for a moment that you can’t read or write; even at a basic level:

How would you apply for, find or hold down work?
If you found work, how could you review your employment contract? How would you communicate with workmates?
If you couldn’t find work, how could you get help with basic needs like unemployment benefits, or with training or housing?
How would you stay in touch with friends who text or use Facebook, Discord or WhatsApp to converse?
How would you travel to places you’ve never been before? What would happen if your voice-guided app or device failed you?
Could you find out about stuff that mattered to you as quickly as friends who could read Google search results?
How could you educate yourself about your legal rights or obligations, e.g. when renting or buying a place to live, taking out a car loan, getting married or divorced, or managing a loved one’s affairs?
How could you resolve disputes or deal with unexpected tasks, like insurance claims or funerals?
How could you read articles like this one?

As we’ve noted before in some detail, poor reading skills can have a big negative life-long effect on your academic, social, and work outcomes (e.g. Snowling et al., 2007).

Now imagine you have a loved one – a teenager or adult in your life – who can’t read properly. How can you find evidence-based help?

What’s needed most

For people of all ages who can’t read properly, phonics decoding and word reading accuracy are essential skills for reading accuracy, fluency and reading comprehension (Carroll et al., 2011). “The case for synthetic phonics is overwhelming and much strengthened by a systematic approach” (Rose, 2006). Learning speech-sound-based decoding skills in an intense, focused, multi-sensory and systematic way can improve word reading, even for people with severe reading problems (e.g. Fletcher et al., 2007; Shaywitz, 2003; Singleton et al., 2009).

Overcoming additional barriers for teenagers and adults

Many reading programs are intended for primary school-aged kids (Brooks, 2007). For teenagers and adults, being given a garish, cartoonish phonics book designed for a 5 year old can be demoralising; even humiliating. This is a big problem: many teenagers and adults who can’t read already have low self-esteem and confidence (Jeffes, 2016). It’s essential that the materials are age-appropriate and that literacy workers don’t treat clients like young children.

What can help

In our clinic, we use a range of age-appropriate resources to help teenagers and adults to read, including texts tailored to a client’s personal, school or work interests and needs.

One resource we use for teenagers and adults with significant reading difficulties was first suggested to me by one of my co-mentors, Nel MacBean of Positive Speech. It’s called “Toe By Toe”.

Toe By Toe is a highly structured – at time almost pedantically so! – evidence-based multi-sensory reading program developed by Keda and Harry Cowling in the United Kingdom. The program has a close focus on phonics instruction and letter-sound links, but the program does not look like a kids’ reader and is never condescending. The more I use it, the more I like it for a number of reasons.

Does it work?

In 2016, Ben Jeffes published a study about Toe By Toe*, looking at outcomes of a 60-minute, once a week, 10-week reading program administered to 30 teenagers in Years 7-10, using the Toe By Toe program. He found that the students:

made statistically significant improvements in phonics decoding accuracy, word recognition accuracy and phonic decoding fluency, which were maintained when re-tested 6 months after the end of the program; but
did not significantly improve their sight word reading fluency, reading comprehension or reading fluency skills (this is why we supplement Toe By Toe with evidence-based comprehension strategies, fluency practice and curriculum or work-based key vocabulary instruction in our clinic).

Interestingly, students reported that they liked the program more than the teachers, noting that the program gave them a chance to improve their reading one-to-one without “simply reading books”.

Our view

We like Toe By Toe because it helps students to:

learn methodically about letter-sound links;
overcome unhelpful and non-evidence-based reading “strategies” like word-guessing based on word shapes or the first letter-sound (so-called analytical phonics);
improve their phonological awareness (e.g. of words with consonant clusters and more than one syllable); and
improve their ability to identify and pronounce common morphemes,

at their own pace with age-appropriate materials. We also find that the later stages of the program (which no student in the study completed) help students with their decoding speed, word recognition and reading fluency skills, although we are not aware of any peer-reviewed studies to date that support our clinical observations to date.

Bottom line

For more than a decade, we’ve known the key skills needed to learn to read: (1) phonological awareness; (2) phonics; (3) fluency; (4) vocabulary; and (5) comprehension. But there is no single reading program that appeals to every age group.

It’s hard to motivate teenagers and adults to learn to read with materials designed for young children, even if the materials are evidence-based. One option for older readers is the Toe By Toe program, which has been shown to increase phonics decoding, word recognition and phonics decoding fluency. But it should be supplemented with instruction in evidence-based reading comprehension strategies, fluency practice (speed and expression), vocabulary instruction relevant to their school/work interests, needs and goals and, in some cases, morphological awareness training.

If you – or someone you know – needs help with their reading, there are many places to look for help – just make sure they are committed to evidenced-based reading instruction.

Related articles:

Principal source: Jeffes, B. (2016). Raising the reading skills of secondary-age students with severe and persistent reading difficulties: evaluation of the efficacy and implementation of a phonics-based intervention programme. Educational Psychology in Practice, 32(1), 73-84.

Additional resource: The Reading Writing Hotline.

* The Jeffes study was designed as a quasi-experimental, two group, baseline/test controlled study, with both groups receiving the training, at different times to measure outcomes. As the author himself notes, the study had lots of limitations, e.g. there was no real control group, the testers weren’t blinded to the groups or the results, and and the results may have been affected by bias, including as a result of the so-called Hawthorne effect where people improve because they know they are being observed and/or establish a good rapport with the people testing them. Importantly, no student completed the full program in 10 weeks, so the study doesn’t necessarily reflect the degree of reading gains that people who complete the program may make.

Image: http://tinyurl.com/lhm3jrz

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

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

David Kinnane · 4 December 2016 · Leave a Comment

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:
- well-developed interpersonal communication, information literacy, critical thinking, and good writing skills are becoming more important in many modern workplaces, especially in white-collar service jobs; and
- many teens and young adults are expected to communicate regularly via SMS and social media platforms to maintain a full social life.

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.

For more information on developmental language disorder (DLD), check out our free DLD guide for families:

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

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language