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Diagnosing and Treating Developmental Language Disorder

​Karla K. McGregor, Ph.D.
Boys Town National Research Hospital​

Developmental language disorder (DLD) is a condition where children have problems understanding and/or using spoken language. DLD is 50 times more prevalent than hearing impairment and five times more prevalent than autism. Children with DLD are considerably slower than other children to develop spoken vocabulary and grammar despite normal intelligence and ample opportunity. DLD is a life-long condition that impairs social and academic functions.

Identifying Developmental Language Disorders (DLD)

Screening for spoken language problems such as DLD is not routine in our schools; although school professionals routinely screen for vision, hearing and reading problems. This is unfortunate because DLD is a common but hidden disability. How does a diagnosis of a child with DLD come about? Typically, the process begins when a caring adult shares concerns about a child's ability to communicate or notices behaviors that could be signs of poor communication such as acting out or failing in the classroom. This adult could be a parent or other relative or professional such as a teacher or pediatrician. A number of red flags in the child's speech and language development can trigger these concerns. The next step is to seek an evaluation from a speech-language pathologist.

Evaluating Communication

A speech-language pathologist performs the evaluation of the child. The nature of the evaluation will depend on the child's age and the concerns that prompted the evaluation. Typically, the speech-language pathologist will assess the child's interest in communicating, the ease with which the child's speech is understandable, and the ability of the child to understand and express words and sentences. The evaluation usually has three steps:

  1. The speech-language pathologist interviews the parents and the teacher, if the child is in school. The goal of the interviews is to document the child's health and educational history and to learn about the child's strengths and weakness in the area of communication.
  2. The speech-language pathologist observes the child during conversation or storytelling. The goal is to note problems pronouncing words, finding the right words, building grammatical sentences, or including relevant information. If the child is in school, the speech-language pathologist will likely observe him in the classroom to document any problems he has understanding his teacher or participating in classroom conversation.
  3. The child will take a battery of standardized tests. The goal of the tests is to compare the child's speech, language and overall communication to expected levels given her age.  

During the evaluation, the speech-language pathologist is trying to answer two key questions:

  1. Is the child significantly poorer in some aspect of speech, language, or overall communication than other children who are the same age?
  2. If so, does this problem prevent the child from functioning well socially, emotionally, or academically?

If the answers are yes, then the speech-language pathologist will determine what kind of problem it is. For example, the speech-language pathologist might administer additional tests to see whether the problem is Childhood Apraxia of Speech or DLD. If the problem is DLD, it might be necessary to see other professionals to diagnose potential co-existing conditions such as Attention Deficit/Hyperactivity Disorder or to rule out potential causes such as Intellectual Disability, Hearing Loss, or Autism Spectrum Disorder. Remember that most cases of DLD do not have a known cause. It is still important to diagnose and treat these cases of DLD.

Assessing the Child's Needs

DLD varies from child to child and from age to age. One preschooler with DLD might need help with learning new words but another might need help following directions. A seventh grader with DLD might require support to organize written work or might benefit from conversational strategies. Once DLD is diagnosed, the speech-language pathologist can complete detailed assessments to determine the specific needs of the individual child. This process is a bridge between diagnosing the problem and reducing the problem.

Finding a Speech-Language Pathologist

Speech-language pathologists work in hospitals, clinics, private practices, and schools. In the U.S., a speech-language pathologist should hold a Master's, Clinical Doctorate, or Ph.D. degree and a certificate of clinical competency from the American Speech-Language-Hearing Association. People who have this certification will have the initials "CCC-SLP" after their signatures. The speech-language pathologist should hold a license to practice in your state of residence. If you are considering a speech-language pathologist in a hospital, clinic, or private practice, be sure to seek one who has ample experience with language problems in children.

By the law specified in the Individuals with Disabilities Act, public schools are required to identify and evaluate, at no charge, children who might need special education or related services such as speech-language therapy. This requirement covers any child from birth to age 21, even if the child does not attend a public school. If you are concerned about your child's communication abilities, it is wise to request an evaluation by a speech-language pathologist at your local public school.

References

https://www.understood.org/en/school-learning/your-childs-rights/basics-about-childs-rights/child-find-what-it-is-and-how-it-works

Paul, R., & Norbury, C. F. (2012). Language disorders from infancy through adolescence: Listening, Speaking. Reading, Writing, and Communicating4. Elsevier Health Sciences.