DLD

Background

DLD is one of the commonest childhood neurodevelopmental disorders which affects communication skills^1,2. DLD, previously known as specific language impairment (SLI), is characterised by persistent difficulties in language development, despite normal hearing and non-verbal intelligence^3,4. It impacts a child's ability to understand and use spoken language, affecting various aspects of their academic, social, and emotional functioning.

The main symptoms are impaired language comprehension and expression. Children with DLD may have difficulty understanding spoken language, following instructions, or comprehending complex sentences. They may also struggle to express themselves effectively, with limited vocabulary, grammatical errors, and challenges informing coherent sentences. These language difficulties can persist into adulthood, leading to frustration, social isolation, and academic underachievement^5,6,7.

The presentation of DLD can vary widely, from mild language difficulties that primarily affect expressive language skills, to more severe impairments that impact both receptive and expressive language abilities. DLD is often accompanied by conditions such as attention deficit hyperactivity disorder, autistic spectrum disorder or specific learning disabilities. This can complicate diagnosis and management.

Diagnosing DLD requires standardised language assessments, observations of language use indifferent contexts, and consideration of developmental history and family background^8,9. It is also essential to rule out other conditions that may mimic DLD or coexist with it, such as hearing impairment or intellectual disability.

Management

Management includes some or all of the following¹⁰:

• Speech and language therapy, focusing on improving language comprehension, expression, and pragmatic skills.
• Educational support services, such as individualised education plans (IEPs) or adaptations in the classroom, to address academic challenges.
• Behavioural interventions, such as social skills training or cognitive-behavioural therapy, to address associated difficulties such as social anxiety or low self-esteem.

It is vital that the families and teachers of children with DLD have access to information about the disorder, strategies for supporting language development, and resources for intervention and support.

References

1. Norbury CF, Gooch D, Wray C et al. The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study. J Child Psychol Psychiatry. 2016 Nov;57(11):1247-1257.
2. Tomblin JB, Records NL, Buckwalter P et al. Prevalence of specific language impairment in kindergarten children. J Speech Lang Hear Res. 1997 Dec;40(6):1245-60.
3. British Dyslexia Association. Developmental language disorder (DLD).
4. Bishop DV, Snowling MJ, Thompson PA et al; CATALISE consortium. CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children. PLoS One. 2016 Jul 8;11(7):e0158753.
5. National Institute on Deafness and Other Communication Disorders. Developmental Language Disorder. May 2023.
6. Botting N. Language, literacy and cognitive skills of young adults with developmental language disorder (DLD). Int J Lang Commun Disord. 2020Mar;55(2):255-265.
7. Nudel R, Christensen RV, Kalnak N et al; DBDS Genomic Consortium; Erikstrup C, Pedersen OB, Burgdorf KS, Ullum H, Ostrowski SR, Hansen TF, Werge T. Developmental language disorder - a comprehensive study of more than 46,000 individuals. Psychiatry Res. 2023
8. Afasic. Identifying and diagnosing DLD.
9. RCSLT. DLD – questions on diagnosis and support. Nov 2020.
10. RCSLT. Developmental language disorder overview.