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How We Fail Children With Developmental Language Disorder.

ABSTRACT: Purpose For over two decades, we have known that children with developmental language disorder (DLD) are underserved. We have also known that DLD does not attract the research attention that it merits given its prevalence and impact. The purposes of this clinical focus article are to present evidence that these failures continue, explore the reasons behind these failures, and propose solutions. Method I reviewed the literature and applied bibliometric analysis procedures from Bishop (2010) to quantify research efforts aimed at DLD compared to other neurodevelopmental disorders. Results The percentage of children who are deemed eligible for clinical services because of DLD continues to fall well short of estimates based on the prevalence of DLD in community samples. The amount of research conducted on DLD relative to other neurodevelopmental disorders remains low. Contributing factors include a lack of awareness of DLD, the hidden nature of DLD, entrenched policies, and the dissonance created when speech-language pathologists must diagnose DLD in school settings. Conclusions Expanded approaches to supporting children with DLD are required. These might include engagement in advocacy and awareness campaigns; clearer communication with the families we serve and enhanced collaborations with classroom teachers; the implementation of school-based language screenings; participation in policymaking; and the development of service delivery models that operate alongside those that exist in our schools and complement their function. Supplemental Material https://doi.org/10.23641/asha.12743273.

SUBMITTER: McGregor KK

PROVIDER: S-EPMC7842848 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Developmental language disorder (DLD) is characterised by difficulties in learning one's native language for no apparent reason. These language difficulties occur in 7% of children and are known to limit future academic and social achievement. Our understanding of the brain abnormalities associated with DLD is limited. Here, we used a simple four-minute verb generation task (children saw a picture of an object and were instructed to say an action that goes with that object) to test children between the ages of 10-15 years (DLD N = 50, typically developing N = 67). We also tested 26 children with poor language ability who did not meet our criteria for DLD. Contrary to our registered predictions, we found that children with DLD did not have (i) reduced activity in language relevant regions such as the left inferior frontal cortex; (ii) dysfunctional striatal activity during overt production; or (iii) a reduction in left-lateralised activity in frontal cortex. Indeed, performance of this simple language task evoked activity in children with DLD in the same regions and to a similar level as in typically developing children. Consistent with previous reports, we found sub-threshold group differences in the left inferior frontal gyrus and caudate nuclei, but only when analysis was limited to a subsample of the DLD group (N = 14) who had the poorest performance on the task. Additionally, we used a two-factor model to capture variation in all children studied (N = 143) on a range of neuropsychological tests and found that these language and verbal memory factors correlated with activity in different brain regions. Our findings indicate a lack of support for some neurological models of atypical language learning, such as the procedural deficit hypothesis or the atypical lateralization hypothesis, at least when using simple language tasks that children can perform. These results also emphasise the importance of controlling for and monitoring task performance.

Project description:We examined whether children with developmental language disorder (DLD) differed from their peers with typical development (TD) in the degree to which they encode information about a talker's mouth shape into long-term phonemic representations. Children watched a talker's face and listened to rare changes from [i] to [u] or the reverse. In the neutral condition, the talker's face had a closed mouth throughout. In the audiovisual violation condition, the mouth shape always matched the frequent vowel, even when the rare vowel was played. We hypothesized that in the neutral condition no long-term audiovisual memory traces for speech sounds would be activated. Therefore, the neural response elicited by deviants would reflect only a violation of the observed audiovisual sequence. In contrast, we expected that in the audiovisual violation condition, a long-term memory trace for the speech sound/lip configuration typical for the frequent vowel would be activated. In this condition then, the neural response elicited by rare sound changes would reflect a violation of not only observed audiovisual patterns but also of a long-term memory representation for how a given vowel looks when articulated. Children pressed a response button whenever they saw a talker's face assume a silly expression. We found that in children with TD, rare auditory changes produced a significant mismatch negativity (MMN) event-related potential (ERP) component over the posterior scalp in the audiovisual violation condition but not in the neutral condition. In children with DLD, no MMN was present in either condition. Rare vowel changes elicited a significant P3 in both groups and conditions, indicating that all children noticed auditory changes. Our results suggest that children with TD, but not children with DLD, incorporate visual information into long-term phonemic representations and detect violations in audiovisual phonemic congruency even when they perform a task that is unrelated to phonemic processing.

Project description:Objective: Developmental language delay (DLD) is one of the most common disabilities in childhood and can negatively affect a child's communication skills and academic and/or psychosocial development. To date, an increasing number of causative genes have been identified by diagnostic techniques like next generation sequencing. An early genetic diagnosis is important to properly prepare and counsel children and parents for possible future difficulties. Despite this, genetic assessment is usually not part of a standardized diagnostic set in children with developmental language delay. In this study, we aim to assess the diagnostic outcomes of children primarily assessed for speech and language delay who were subsequently referred for genetic etiological assessment. Methods: Medical records of children referred to the department of Otorhinolaryngology of the Wilhelmina Children's Hospital for diagnostic work-up for a suspected speech and language delay between June 2011 and December 2018 who were additionally referred to a geneticist were evaluated. Study parameters concerning medical history, behavioral problems, language development, intelligence, and hearing were recorded. Outcomes of genetic analysis were evaluated. Results: A total of 127 patients were diagnosed with a developmental language delay. Genetic analysis was conducted in 119 out of 127 patients with a language delay and eligible for this study. The median time between initial speech and language assessment and the first genetic consultation was 10 months (IQR 5.0-23.0). In 34 out of 127 patients a causative genetic diagnosis was found to explain their DLD. Conclusion: In approximately a quarter of the patients (26.8%) diagnosed with developmental language delay, a causative genetic diagnosis was confirmed. This demonstrates the opportunity to identify an underlying genetic etiology in children with developmental language delay. However, in order to optimize the diagnostic process and clinical care for these children, two important research gaps need to be addressed. First, research should focus on assessing the clinical impact and effect on treatment outcomes of a genetic diagnosis. Secondly, it is important to recognize for which children genetic testing is most beneficial.

Project description:Purpose Word learning difficulties have been documented in multiple studies involving children with dyslexia and developmental language disorder (DLD; see also specific language impairment). However, no previous studies have directly contrasted word learning in these two frequently co-occurring disorders. We examined word learning in second-grade students with DLD-only and dyslexia-only as compared to each other, peers with both disorders (DLD + dyslexia), and peers with typical development. We hypothesized that children with dyslexia-only and DLD-only would show differences in word learning due to differences in their core language strengths and weaknesses. Method Children (N = 244) were taught eight novel pseudowords paired with unfamiliar objects. The teaching script included multiple exposures to the phonological form, the pictured object, a verbal semantic description of the object, and spaced retrieval practice opportunities. Word learning was assessed immediately after instruction with tasks requiring recall or recognition of the phonological and semantic information. Results Children with dyslexia-only performed significantly better on existing vocabulary measures than their peers with DLD-only. On experimental word learning measures, children in the dyslexia-only and DLD + dyslexia groups showed significantly poorer performance than typically developing children on all word learning tasks. Children with DLD-only differed significantly from the TD group on a single word learning task assessing verbal semantic recall. Conclusions Overall, results indicated that children with dyslexia display broad word learning difficulties extending beyond the phonological domain; however, this contrasted with their relatively strong performance on measures of existing vocabulary knowledge. More research is needed to understand relations between word learning abilities and overall vocabulary knowledge and how to close vocabulary gaps for children with both disorders. Supplemental Material https://doi.org/10.23641/asha.14832717.

Project description:Previous studies have shown that most English-speaking children with language difficulties show academic difficulties during their schooling. The present study aimed to describe the academic achievement of children speaking Spanish and Catalan with developmental language disorder (DLD) during their primary education and to predict their academic outcomes using several processing skills assessed at the beginning of their schooling. To this end, we followed 28 children during their schooling (6-12 years of age). Participants were divided into two groups, one with DLD (n = 14) and a control group (n = 14) paired by age, gender, socio-economic status (SES), family language (L1), and classroom. All participants were assessed through different processing skills with the Spanish version of the NEPSY at the beginning of their schooling (age 6): attention (visual attention, auditory attention, and response set), phonological awareness, verbal short-term memory (sentence repetition, and narrative memory), access to language (semantic verbal fluency and rapid naming), and language comprehension (comprehension of verbal commands). At the end of primary education, schools reported the official academic marks at the 1st cycle (6-8 years), 2nd cycle (8-10 years) and 3rd cycle (10-12 years). Direct scores of the processing skills and academic results were used for statistical analyses. Results showed that children with DLD had more frequent grade retention, and their academic marks were significantly lower than those of their peers in all the cycles and for all academic subjects with a high language dependency (all except physical education and mathematics). Those subjects with lower language dependence did not show significant differences (physical education and mathematics). Rapid naming accounted for most of the variance of academic outcomes, followed by phonological awareness, and language comprehension when both groups were taken together. Only rapid naming accounted for academic results in the DLD group and phonological awareness did so for the control group. In sum, children with DLD experienced more academic difficulties during their primary education. Those children (with and without DLD) who experienced difficulties not only with rapid naming but also with phonological awareness and oral language comprehension at the beginning of their schooling showed a higher probability of academic failure.

Project description:Background and aimChildren with Developmental Language Disorder (DLD) are at an increased risk to develop behaviors associated with Autism Spectrum Disorder (ASD). The relationship between early language difficulties and the occurrence of ASD-related behaviors in DLD is poorly understood. One factor that may hinder progress in understanding this relationship is the etiological heterogeneity of DLD. We therefore study this relationship in an etiologically homogeneous group of children, who share phenotypic characteristics with children with DLD: children with the 22q11.2 Deletion Syndrome (22q11DS). We compare children with 22q11DS, to children with DLD and age-matched typically developing children (TD).Method44 children with 22q11DS, 65 children with DLD and 81 TD children, between 3.0-6.5 years old, participated in a longitudinal cohort study that included a baseline measure and a follow-up measure with a 1-year interval. A parental questionnaire (SRS-2) was used to measure the incidence of behaviors in two key behavioral domains associated with ASD: Social Communication and Interaction and Restricted Repetitive Behaviors and Interests. At baseline, we assessed children's expressive and receptive language abilities as well as their intellectual functioning with standardized tests. We compared the distribution of ASD-related behaviors between the three groups. We used regression analyses to investigate whether language abilities at baseline predict ASD-related behavior at follow-up, accounting for ASD-related behavior at baseline, demographic variables and intellectual functioning.ResultsBoth the children with 22q11DS and the children with DLD displayed significantly more ASD-related behaviors than the TD children. Over 30% of children in both clinical groups had scores exceeding the subclinical threshold for ASD in both behavioral domains. Both in 22q11DS and DLD, baseline receptive language scores were negatively correlated with ASD-related behaviors 1 year later, when controlling for baseline SRS-scores. However, this association was statistically significant only in children with 22q11DS, even when controlled for IQ-scores, and it was significantly stronger as than in the TD group. The strength of the association did not differ significantly between 22q11DS and DLD.ConclusionBoth children with 22q11DS and children with DLD present with elevated rates of ASD-related behaviors at a preschool-age. Only in children with 22q11DS we observed that weaker receptive language skills were related to increased behavioral problems in the domain of social communication and interaction one year later.ImplicationsOur findings indicate that relations between early language impairment and other behavioral phenotypes may be more feasible to detect in a subgroup of children with a homogeneous etiology, than in a group of children with a heterogeneous etiology (such as children with DLD). Our results in 22q11DS reveal that receptive language is especially important in predicting the occurrence of ASD-related behaviors. Future research is needed to determine to what extent receptive language predicts the occurrence of ASD-related behaviors in children with DLD, especially among those children with DLD with the weakest receptive language. Clinically, screening for ASD-related behaviors in children with developmental language difficulties is recommended from a young age, especially among children with receptive language difficulties.

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How We Fail Children With Developmental Language Disorder.

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