FAQs for the IALP Child Language Committee
DEVELOPMENTAL LANGUAGE DISORDER
Question: Should speech-language pathologists use the term Developmental Language Disorder (at all times)?
Answer: The IALP Child Language Committee
Developmental Language Disorder (DLD) is the term recommended by an international team of professionals to refer to children with a significant language impairment that is persistent and has a functional impact on education and socio-emotional well-being (Bishop et al., 2017). DLD affects approximately 7% of the population (Norbury et al 2016). It can be diagnosed at any point in childhood or adolescence, generally affects both oral and written language during the school years, and extends into adulthood. DLD is diagnosed when language disorders are evident and cannot be better explained by another primary diagnosis such as autism spectrum disorder, sensorineural hearing loss, or intellectual impairment. If such conditions exist, a diagnosis of “language disorder associated with X” can be applied. It is accepted that DLD often co-occurs with disorders in cognitive, sensorineural and motor domains, such as attentional problems and motor problems. In this case the language disorder is the primary condition and thus the diagnosis would be, for example, “DLD with attention deficit disorder,” or “DLD with developmental co-ordination disorder” (Bishop et al., 2017).
The Child Language Committee agrees that widespread adoption of the term, Developmental Language Disorders, has a number of advantages, including advocating for services for those impacted and increasing public awareness in order to improve identification and attract research funding. However, the Child Language Committee acknowledges there are some challenges associated with this change in terminology. One challenge is that the DSM-5 has a broad category for Language Disorder but does not refer to the term Developmental Language Disorder. Another challenge is that eligibility for services or second party reimbursement policy may be encoded with other terminology, which cannot be easily changed in the short term (e.g. “Speech or Language Impairment” [US federal law]). In those cases, the Child Language Committee advocates for the use of terminology that is in the best interest of the child or adolescent. Whenever possible, the Child Language Committee recommends using the term Developmental Language Disorder (perhaps in conjunction with existing terminology) to help raise awareness and support the adoption of this term.
Bishop, D. V., Snowling, M. J., Thompson, P. A., Greenhalgh, T., Catalise‐2 Consortium, Adams, C., … & house, A. (2017). Phase 2 of CATALISE: A multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology. Journal of Child Psychology and Psychiatry, 58(10), 1068-1080.
Norbury, C. F., Gooch, D., Wray, C., Baird, G., Charman, T., Simonoff, E., … & Pickles, A. (2016). The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study. Journal of child psychology and psychiatry, 57(11), 1247-1257.
Question: What is Developmental Language Disorder?
Answer: Dr Mary Claessen (Australia)
Many children experience difficulties learning language both receptive (comprehension) and expressive. Many of these children experience difficulties learning to read and write and the difficulties often persist into adulthood and impact education, employment and quality of life. Yet for many years there has been a lack of agreement about what term to use to describe this population. Perhaps as a result, the general public have little awareness about language impairment and the lifelong impact of such a disorder, particularly compared with other conditions such as Autism Spectrum Disorder.
Recently, a Delphi Consensus study was published, that recommended use of the term Developmental Language Disorder or DLD, to describe language difficulties that arise in childhood and are significant, persistent, and have a functional impact. A diagnosis of DLD should only be made after a comprehensive assessment which combines information from a range of sources including caregiver and educator reports. Diagnosis of DLD in children younger than four is not recommended as many children who are late to talk catch up without any additional help, and there are currently no criteria which reliably identify children whose language difficulties will persist. Consider describing this population as having language difficulties rather than DLD.
Language disorders frequently co-occur with other difficulties in areas such as attention, motor control and social difficulties. Such children can be described as having Developmental Language Disorder with co-occurring attention/ motor control etc difficulties. Language difficulties are also frequently associated with other biomedical conditions such as Down Syndrome and Autism Spectrum Disorder. This group of children can be referred to as having Language Disorder associated with X (Down Syndrome etc).
Bishop, D. V., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & Catalise Consortium. (2016). CATALISE: A multinational and multidisciplinary Delphi consensus study. Identifying language impairments in children. PLOS one, 11(7), e0158753.
Bishop, D. V., Snowling, M. J., Thompson, P. A., Greenhalgh, T., Catalise‐2 Consortium, Adams, C. (2017). Phase 2 of CATALISE: A multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology. Journal of Child Psychology and Psychiatry, 58(10), 1068-1080.
Question: Is it possible to identify and diagnose accurately children with Developmental Language Disorder in a dialectal situation?
Answer: Dr Elena Theodorou (Croatia)
Identifying and diagnosing children with Developmental Language Disorder is recognized internationally by speech and language therapists as exceptionally challenging. This situation becomes even harder when the child’s first language is different from the standard language. This is the case for many countries where one or more dialects co-exist with a standard variety of the language. It is important to distinguish between language variation in dialectal situations and language impairment. Further, research has highlighted the need for language tests that take into account linguistic characteristics of the dialect (e.g. Theodorou, et al., 2019; Oetting, 2018; Bedore, et al., 2018; Theodorou, et al., 2016). Many norm-referenced tests have been published in different languages that evaluate language abilities of children who are speakers of the Standard language. Thordardottir and her colleagues (2011) suggested that the language differences between the dialect and standard language may not always be important so as to rule out the use of such tests for identification of children with impaired language. They also suggested that appropriate modifications can be made in order for the tests to be effective for children who are dialect speakers. This was confirmed by Theodorou and her colleagues (2016) who showed that tests, which were developed to assess language abilities of children who speak Standard Modern Greek were appropriate to identify children whose first language is the Cypriot Greek dialect, if the appropriate modifications are made. Therefore, it is possible to accurately identify and diagnose those individuals with Developmental Language Disorder whose native language differs from the mainland variety but the assessor must recognize the linguistic situation of the person being assessed.
Bedore, L. M., Peña, E. D., Anaya, J. B., Nieto, R., Lugo-Neris, M. J., & Baron, A. (2018). Understanding Disorder Within Variation: Production of English Grammatical Forms by English Language Learners. Language, Speech, and Hearing Services in Schools, 49, 277–291. https://doi.org/10.1044/2017_LSHSS-17-0027
Theodorou, E., Petinou, K., & Kambanaros, M. (2019). National vignette: Cyprus vignette. In Law, J., McKean, C., Murphy, C.-A., & Thordardottir, E., (Eds.), Managing Children with Developmental Language Disorder: Theory and Practice Across Europe and Beyond (pp 179–188). England: Routledge.
Oetting, J. B. (2018). Prologue: Toward Accurate Identification of Developmental Language Disorder Within Linguistically Diverse Schools. Language, Speech, and Hearing Services in Schools, 49, 213–217. https://doi.org/10.1044/2018_LSHSS-CLSLD-17-0156
Theodorou, E., Kambanaros, M., & Grohmann, K. K. (2016). Diagnosing bilectal children with SLI: Determination of identification accuracy. Clinical linguistics & phonetics, 30(12), 925–943.
Thordardottir, E., Kehayia, E., Mazer, B., Lessard, N., Majnemer, A., Sutton, A., Trudeau, N., & Chilingaryan, G. (2011). Sensitivity and specificity of French language and processing measures for the identification of primary language impairment at age 5. Journal of Speech Language Hearing Research, 54, 580–597
Question: What methods can be used to seek and prioritise the voice of children and young people with language disorders?
Answer: Dr Rena Lyons (Ireland)
Much of our knowledge about language disorders comes from research underpinned by a positivist paradigm with a focus on measurement of linguistic, cognitive, and psychosocial variables. Although this research has enhanced our knowledge and understanding of processes underpinning language disorders, as well as evidence in relation to assessment and intervention, little is known about the experiences of children and young people with language disorders. According to Article 12 of the United Nations Convention on the Rights of the Child (United Nations, 1989), children have the right to express their views on all matters affecting them. Researchers and practitioners may ask parents about their children’s views rather than asking children themselves. These proxy reports are problematic because the perspectives of children and parents may differ (and may not reflect children’s feelings and views.
Research with children with language disorders is still in its early days. Researchers have been using qualitative methods to seek and prioritise the views of children and young people with language disorders. Given that qualitative research data collection and analysis methods are based on generating and analyzing talk, it is important that a range of methods are used flexibly, without compromising rigour, to enable children with language disorders to have their say. A range of methods have been used to explore the views of children with language disorders: bespoke picture resources to support children with speech and language disorders to talk about talking in everyday activities (Merrick, 2014); interviews combined with visual methods such as photography, visual supports, drawings (Lyons & Roulstone, 2018; Tancredi, 2019); and focus groups (Markham et al., 2009). In recent years, the views of children with language disorders have been sought regarding speech and language therapy provision in schools (Gallagher, Murphy, Conway, & Perry, 2019) and setting research priorities (Chadd, Kulkarni, & Longhurst, 2020). However, the field is still in its early days of using these methods and it is important to critically reflect on these methods, understand their limitations, and how they can be improved. Children’s views could inform assessment and shape the design of interventions e.g., the inclusion of goals that are important to them in their everyday lives.
Gallagher, A. L., Murphy, C. A., Conway, P. F., & Perry, A. (2019). Engaging multiple stakeholders to improve speech and language therapy services in schools: an appreciative inquiry-based study. BMC Health Services Research, 19(1), 226-226. doi:10.1186/s12913-019-4051-z
Chadd, K. E., Kulkarni, A. A., & Longhurst, L. M. (2020). Involving Individuals with Developmental Language Disorder and their Parents/Carers in Research Priority Setting. JoVE(160), e61267. doi:10.3791/61267
Lyons, R., & Roulstone, S. (2018). Well-Being and Resilience in Children With Speech and Language Disorders. Journal of Speech, Language, and Hearing Research, 61(2), 324-344. doi:10.1044/2017_JSLHR-L-16-0391
Merrick, R. (2014). Picture Me: Children’s Views of Speech, Language and Communication Needs. Guildford, England: J & R Press.
Tancredi, H. (2019). Meeting obligations to consult students with disability: methodological considerations and successful elements for consultation. The Australian Educational Researcher, 1-17.
Question: How do children’s language abilities relate to their quality of life?
Answer: Professor Cristina McKean (UK)
The World Health Organisation defines Quality of Life as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns (WHO n.d.). In research studies this construct is often measured using Health Related Quality of Life tools (HRQoL) where the child or their parents reports on their perceptions of their HRQoL.
To examine relationships between language ability and HRQoL the most valid approach is to examine population cohorts which represent all children in a community, not only those who are referred to clinical services. Children with low language abilities (usually defined as achieving a score on a standardised omnibus language measure falling > 1.25 SD below the mean) are at substantially increased risk of experiencing reduced HRQoL and this can be present relatively early in the child’s development. McKean et al (2017) found that at 7 years approximately one third of children with low language abilities experience reduced HRQL in school, psychosocial and emotional domains. This is compared to 12 to 15% in children with typical language.
Importantly HRQoL can change over time. Eadie at al. (2018) and Le et al. (2020) have demonstrated the potential for a worsening trajectory in HRQoL between 4 and 13 years in children with low language abilities, with more than half experiencing this worsening pattern.
It is important to note that not all children with language difficulties experience reduced HRQoL. Co‐occurring social–emotional problems appear to play an important role in increasing such risks. The functional impacts of low language abilities must be monitored over time. Children who appear to have good quality of life in early school years may begin to feel differently as they move into adolescence. Interventions should not only aim to improve children’s language ability but also address the wider functional impacts of low language and these interventions must extend into the teenage years if we are to fully meet the needs of children and young people with language difficulties.
Eadie, P., Conway, L., Hallenstein, B., Mensah, F., McKean, C. and Reilly, S., (2018). Quality of life in children with developmental language disorder. International Journal of Language & Communication Disorders, 53(4), pp.799-810.
Le, H.N., Mensah, F., Eadie, P., McKean, C., Sciberras, E., Bavin, E.L., Reilly, S. and Gold, L., (2020). Health‐related quality of life of children with low language from early childhood to adolescence: results from an Australian longitudinal population‐based study. Journal of Child Psychology and Psychiatry. doi:10.1111/jcpp.13277
McKean, C., Reilly, S., Bavin, E.L., Bretherton, L., Cini, E., Conway, L., Cook, F., Eadie, P., Prior, M., Wake, M. and Mensah, F., (2017). Language outcomes at 7 years: Early predictors and co-occurring difficulties. Pediatrics, 139(3), e20161684. doi: 10.1542/peds.2016-1684
World Health Organisation (n.d.) Health Statistics and information systems https://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/
Question: Why should we raise public awareness of DLD?
Answer: Dr Jelena Kuvac Kraljevic (Croatia)
Developmental language disorder (DLD) is a hidden disability and its symptoms are not always obvious at the first glance. Consequently, children with DLD may be considered lazy or their potential to learn underestimated. Despite similar numbers of boys and girls having DLD, significantly more boys are referred to services for support (Norbury et al., 2016).
Therefore it is important to raise public awareness to:
- Increase knowledge about some condition that leads to change of the public mind-set.
- Minimise social barriers and ensuring full integration of children and young people with DLD in society.
- Improve education policy e.g. ensuring more inclusive schooling.
- Increase referrals for specialist support.
There are different ways to raise public awareness. It can be done through specific planned activities and education, campaigns, websites, posters, television and radio shows, newspaper or any other publicly available medium. It is well known that long-term awareness raising campaign is more effective than large but short-term one. However, involving parents and children with DLD in a public awareness campaign is crucial as they can best describe their experience of living with DLD.
In order to raise the awareness of language disorders in the world, RADLD (Raising Awareness of Developmental Language Disorders) was launched in 2011. Every year in mid-October, the International Developmental Language Disorder Awareness Day is celebrated. Let’s join this campaign and increase the visibility of children with DLD: the difficulties that they face and their strengths and achievements.
Bishop., D.V.M., Clark, B., Conti-Ramsden, C., Norbury, C. F., Snowling, M. J: (2012) RALLI: An internet campaign for raising awareness of language learning impairments. Child Language Teaching and Therapy, 28(3), 259-262.
The Council of Europe. Factsheet on the Awareness Raising on the Rights of Peasons with Disability. Downloaded April 20, 2020. https://rm.coe.int/factsheet-awareness-rev-2-/16808b4e46
Kuvac Kraljevic, J. (2015). Recognition and education of children with language disorders. Zagreb: Faculty of Rehabilitation and Educational Sciences.
Law, J., McKean, C., Murphy, C-A., Thordardottir, E. (2019) Managing Children with Developmental Language Disorder: Theory and Practice across Europe and Beyond. London: Routledge.
Norbury, C. F., Gooch, G., Wray, C., Baird, G., Charman, T., Simonoff, E., Vamvakes, G., Pickles, A. (2016). The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study. Journal of Child Psychology and Psychiatry.
Pitanje: Zašto trebamo povećati svjesnost javnosti o razvojnom jezičnom poremećaju (RJP)?
Odgovor: Dr Jelena Kuvac Kraljevic (Croatia)
Razvojni jezični poremećaj (RJP) prikrivena je teškoća čiji simptomi nisu uvijek vidljivi na prvi pogled. Često se može čuti kako su djeca koja imaju RJP lijena ili se njihovi potencijali za učenje podcjenjuju. Štoviše, procjenjuje se da je tek nešto malo više od polovice sve djece s RJP-om, među kojima više djevojčica, uključeno u neki oblik podrške (Norbury i sur., 2016). Stoga podizanje svjesnosti ima važnu ulogu u prevladavanju negativnih stavova o RJP-u, povećanju podrške i smaniivanju marginalizacije i socijalne isključenosti koju djeca s RJP-om često osjete. Svjesnost javnosti razina je razumijevanja koju javnost ima o prirodi različitih stanja – u ovom slučaju RJP-a i posebnih potreba koje djece i mladi s RJP-om imaju. Doprinosi podizanja svjesnosti javnosti su:
- Povećavanje znanja o određenim stanjima koje vode do promjene u stajalištima javnosti.
- Umanjivanje socijalnih prepreka i osiguravanje pune integracije djece i mladih s RJP-om u društvo.
- Unaprjeđivanje obrazovnih politika primjerice, osiguravanje još inkluzivnijih škola.
- Povećavanje podrške specijalista.
Postoje različiti načini podizanja svjesnosti javnosti. To se može napraviti putem posebno planiranih aktivnosti i edukacija, kampanja, mrežnih stranica, postera, televizijskih i radijskih emisija, novina i bilo kojih drugih javno dostupnih medija. Poznato je da je dugotrajna kampanja podizanja svjesnosti javnosti učinkovitija nego jedna velika, ali kratkotrajna. Dakako, uključenost roditelja i djece s RJP-om u kampanjama podizanja svjesnosti javnosti jako je važna, jer samo oni mogu najbolje opisati svoja iskustva življenja s RJP-om.
Kako bi se povećala svjesnost o jezičnom poremećaju u svijetu, pokrenut je 2011. RADLD (Povećavanje svjesnosti o razvojnom jezičnom poremećaju). Svake godine sredinom listopada
Obilježava se Međunarodni dan o razvojnom jezičnom poremećaju. Priključimo se toj kampanji i
Povećajmo vidljivost djece s RJP-om: teškoće s kojima se oni suočavaju te njihove jake strane i postignuća.
Question: What are personal narratives and why are they important?
Answer: Professor Carol Westby (USA)
Personal narratives are the stories we tell ourselves about our own experiences. They depend on our autobiographical memories – memories of the who, where, when, and the emotions associated with the experiences (Westby & Culatta, 2016). Children develop autobiographical memory and the ability to tell personal narratives during their preschool years by reminiscing with caregivers about shared experiences (Reese, 2013). Adult reminiscing with children contributes not only to children’s ability to tell coherent personal narratives, but also coherent fictional narratives – which are highly correlated with academic success. Coherent narratives require understanding of temporal and causal relationships. During elementary school years, children learn to tell coherent stories about themselves by sequencing activities occurring in single experiences. Adolescents begin to tell their life stories, sequencing a series of events over time and explaining the reasons for their actions.
It is through sharing our personal stories that we establish and maintain social relationships. Telling coherent stories about our experiences is a way of making sense of the experiences and coming to understand who we are (Fivush, 2019). Through telling personal narratives children and adolescents develop a sense of their identity over time; and a sense of identity contributes to psychological well-being, even if one has had some bad experiences. We use our personal narratives about past experiences to guide our future behavior. We think, “I won’t do that again.” or “The next time I’ll plan ahead and give myself more time.” If persons cannot tell coherent stories about their experiences, they are likely to have difficulty regulating their own behavior. They may think events just happen to them by chance; they are unaware that is some instances they can have a role in or responsibility for the outcomes of events. We can use personal narratives of our past experiences to plan strategies to achieve future goals. Assessment of children’s narrative skills should consider their competency in telling both fictional and personal narratives. Coherence of their fictional narratives predicts their academic performance Griffin et al., 2004); coherence of their personal narratives predicts their psychological well-being (Fivush et al., 2010).
Fivush, R. (2019). Family narratives and the development of an autobiographic self. Routledge.
Fivush, R., Bohanek, J. G., & Marin, K. (2010). Patterns of family narrative co-construction in relation to adolescent identity and well-being. In K. C. McLean & M. Pasupathi (Eds.), Narrative development in adolescence: Creating the storied self (pp. 45–63). Springer.
Griffin, T. M., Hemphill, L., Camp, L., & Wolf, D. P. (2004). Oral discourse in the preschool years and later literacy skills. First Language, 24(2), 123–147.
Reese, E. (2013). Tell me a story: Sharing stories to enrich your child’s world. Oxford.
Westby, C.E., & Culatta, B. (2016). Telling tales: Personal event narratives and life stories. Language Speech and Hearing Services is Schools, 47, 260-282.
Question: What abilities and skills does the child need in order to tell a coherent personal narrative?
Answer: Dr. Khaloob Kawar (Israel)
Narration requires an integration of linguistic skills, cognitive skills, literacy, world knowledge and awareness of the listener’s knowledge in order to produce a semantically coherent and a linguistically cohesive message with all narrative components. The narrator needs to focus on the events, making use of working memory to activate and retrieve knowledge related to the story in order to interpret the narrated events and organize these interpretations into a text (Trabasso & Stein, 1994). In addition, the narrator needs cognitive knowledge of temporal and cause-effect relationships as well as ‘theory of mind’ (Kawar, Walters & Fine, 2019; Stadler & Ward, 2005). Elementary school children should tell personal event narratives that are coherent in terms of a concept of biography (what should be put into a personal story) and temporal coherence (reporting a logical temporal sequence of events). Adolescents should tell life stories that are coherent not only in terms of a concept of biography and temporal coherence, but also in terms of causal coherence (making connections between events and one’s needs, goals, or personality) and thematic coherence (seeing similarities in one’s experiences) (Habermus & Bluck, 2000).
Habermus, T., & Bluck, S. (2000). Getting a life: The emergence of the life story in adolescence. Psychological Bulletin, 126(5), 748-769.
Kawar, K., Walters, J., & Fine, J. (2019). Narrative Production in Arabic-speaking Adolescents with and without Hearing Loss. The Journal of Deaf Studies and Deaf Education, 24(3), 255-269. doi: 10.1093/deafed/eny048
Stadler, M. A., & Ward, G. C. (2005). Supporting the narrative development of young children. Early Childhood Education Journal, 33(2), 73-80.
Trabasso, T., & Stein, N. L. (1994). Using goal-plan knowledge to merge the past with the present and the future in narrating events on line. The Development of Future-Oriented Processes, 323-352.
Question: At what age do we expect children to tell a whole structured narrative about a personal experience?
Answer: Dr Khaloob Kawar (Israel)
Narrative is a discourse type that influences and is influenced by communication skills and written language, involving academic, cognitive, pragmatic, psycholinguistic abilities and social skills. Narratives develop from a description of individual events, to a chronological sequence of events, and then to a prototypical narrative structure, in other words “the classic pattern” of narrative. The acquisition of narrative abilities differs across languages, cultural background and ethnic groups (Berman & Slobin, 1994; Kawar, Walters & Fine, 2019).
The development of narratives has been shown to begin at about age two. At age two, children begin to talk about past events. Three and four year olds, children talk about one or more events and use structural narrative components of information setting, events, complications and endings or outcomes. However, their narratives are generally vague and the events are not linked across the narrative (Berman & Slobin, 1994). At age four, the most common narrative structures found were either ‘leap-frog’ narratives, in which children jump from one event to another and omit significant events, or ‘chronological’ narratives, in which they provide simple recounts of major events. Five to seven year olds pay more attention to general story organization. Their narratives include information about place, time and characters, and they show abilities to understand basic emotions and intentions. At age six, children mainly use the classic narrative pattern, which is built around a high point and after evaluating it, the narrator resolves it (Peterson & McCabe, 1983). Eight and nine year old children use larger and more varied use of evaluation methods as well as appropriate cohesion devices (Peterson & McCabe, 1983; Berman & Slobin, 1994). Around age ten to eleven, stories become more complex, more detailed and structurally coherent. Narrative continues to develop through adolescence and even into adulthood.
Berman, R. A., & Slobin, D. I. (2013). Relating events in narrative: A Crosslinguistic Developmental Study. Psychology Press.
Kawar, K., Walters, J., & Fine, J. (2019). Narrative Production in Arabic-speaking Adolescents with and without Hearing Loss. The Journal of Deaf Studies and Deaf Education, 24(3), 255-269. doi: 10.1093/deafed/eny048
Peterson, C., & McCabe, A. (1983). Three ways of looking at a child’s narrative: A psycholinguistic analysis. New York: Plenum. ROSCH, E.(1975). Cognitive representations of semantic categories. Journal of Experimental Psychology, 104, 192-233.
Question: Are all reading problems dyslexia?
Answer: Associate Professor Marleen Westerveld (Australia)
The ultimate aim of learning to read is to read for meaning. The Simple View of Reading (SVR; ref) poses that reading comprehension is the product of decoding and language comprehension, with the contribution of each component changing as children progress at school. During the early years, as children are learning to read, much of the variance in reading comprehension is explained by the child’s ability to decode words. Once children have learned to accurately and fluently decode words, usually around the third or fourth year of schooling, language comprehension explains most of the variability in reading comprehension. Based on this SVR, children who struggle with reading comprehension can be classified into three main groups:
1) children with dyslexia (or specific word reading difficulties) are those who show significant decoding difficulties but show sufficient language comprehension skills. These children often have phonological processing difficulties (including phonological awareness, rapid automatic naming and/or phonological memory). It is estimated that 5-10% of children demonstrate dyslexia;
2) children with specific comprehension difficulties show adequate decoding skills but significant language comprehension difficulties. Children with this reading profile often demonstrate language comprehension weaknesses across vocabulary, grammar, and higher-order language skills such as oral narrative skills. Approximately 17% of children in school may show this type of reading difficulty.
3) children with a mixed reading difficulties profile are those children who show difficulties across decoding and language comprehension. Research indicates that about 30% of children who show difficulties in reading comprehension have this type of reading profile.
Detailed assessment of both spoken and written language skills is clearly required to better understand the nature of each child’s reading difficulties. Gillon (2018) introduced the speech-to-print profile to describe the strengths and weaknesses in spoken and written language skills required for successful reading comprehension. Using this profile will promote collaborative practice and assist educators, speech pathologists and other professionals involved in the teaching of reading in creating a visual representation of a child’s strengths and weaknesses to promote detailed goal setting and intervention planning to ensure reading success for all children. This process is described in detail in Westerveld, Armstrong, and Barton (2020).
Gillon, G. T. (2018). Phonological awareness: From research to practice (Second ed.). New York: The Guilford Press.
Tunmer, W. E., & Hoover, W. A. (2019). The cognitive foundations of learning to read: a framework for preventing and remediating reading difficulties. Australian Journal of Learning Difficulties, 24(1), 75-93. https://doi.org/10.1080/19404158.2019.1614081
Westerveld, M. F., Armstrong, R., & Barton, G. (2020). Reading Success in the Primary Years: An Evidence-Based Interdisciplinary Approach to Guide Assessment and Intervention Singapore: Springer Open. https://link.springer.com/book/10.1007%2F978-981-15-3492-8
Question: Why is it important to focus on phonological awareness development in children who have speech and language disorders?
Answer: Professor Gail Gillon (New Zealand)
Children’s phonological awareness ability (their awareness of the sound structure of words within their language) is critical to their early reading and writing success (Gillon, 2017), particularly in alphabetic languages. Children who enter school with speech and language difficulties are at heightened risk for persistent literacy difficulties (Lewis et al., 2019, McLeod et al., 2019). It is therefore important that these children’s phonological awareness skills are developing in response to quality classroom instruction and speech and language interventions provided.
The aspect of phonological awareness that is most useful to focus on for children with speech and language difficulties is the phoneme level. For example, game activities that promote children’s ability to identify the first phoneme in a word, to segment a word into individual phonemes, to blend phonemes to form words. It is more efficient in terms of treatment outcomes to integrate letter-sound knowledge within the phonological awareness activities. Culturally responsive approaches to phonological awareness interventions that acknowledge children’s cultural identity through for example story and activity choices are encouraged (Gillon & Macfarlane 2017).
It is particularly important for children with speech and language difficulties that explicit instruction is provided to help these children transfer improved phonological awareness skills to the reading and writing process. Intervention trials have shown that is possible through an integrated intervention approach to improve speech, vocabulary, letter-sound knowledge and /or reading and spelling concurrently in young children that have speech and language difficulties (see references within Gillon, 2017). An integrated approach where children’s speech or vocabulary target goals, for example, are included in phoneme awareness games helps maximise the efficiency of specific interventions (see the Better Start Literacy Approach website for video examples and free resources https://www.canterbury.ac.nz/childwellbeing/betterstartliteracy/)
A recent intervention trial in New Zealand (Gillon, et al, 2019) demonstrated the benefits of speech language therapist’s co constructing phonological awareness and vocabulary interventions with class teachers in accelerating the early reading success of children who enter school with low levels of oral language ability. This study highlighted the important role speech-language therapists play in supporting preschool and junior school teachers strengthen the development of children’s phonological awareness skills through quality language learning experiences.
Gillon, G. (2017). Phonological Awareness: From Research to Practice. (2nd ed.). New York: Guilford Press. https://www.guilford.com/books/Phonological-Awareness/Gail-Gillon/9781462532889 G. Gillon and B. McNeill free chapter to down load from book G. https://www.guilford.com/add/gillon_chapter6.pdf
Gillon, G. T., McNeill, B. C., Scott, A., Denston, A., Wilson, L., Carson, K., & Macfarlane, A. H. (2019). A better start to literacy learning: findings from a teacher-implemented intervention in children’s first year at school. Reading and Writing, 32(8), 1989-2012. Open access https://link.springer.com/article/10.1007/s11145-018-9933-7
Gillon, G. T., & Macfarlane, A. H. (2017). A culturally responsive framework for enhancing phonological awareness development in children with speech and language impairment. Speech, Language and Hearing, 20(3), 163-173. Open access https://www.tandfonline.com/doi/full/10.1080/2050571X.2016.1265738
Lewis, B. A., Freebairn, L., Tag, J., Igo, R. P., Jr., Ciesla, A., Iyengar, S. K., . . . Gerry Taylor, H. (2019). Differential long-term outcomes for individuals with histories of preschool speech sound disorders. American Journal of Speech-Language Pathology, 28(4), 1582-1596.
McLeod, S., Harrison, L. J., & Wang, C. (2019). A longitudinal population study of literacy and numeracy outcomes for children identified with speech, language, and communication needs in early childhood. Early Childhood Research Quarterly, 47, 507-517.
University of Canterbury, Child Well-being Research Institute: Better Start Literacy Approach website https://www.canterbury.ac.nz/childwellbeing/betterstartliteracy/
Question: What should be the role of the speech-language pathologist in reading for children and adolescents?
Answer: Professor Nickola Wolf Nelson (USA)
Some people question whether speech-language pathologists (SLP) have a role in reading and written language, but there are three key reasons why our role is essential and varied. They relate to the nature of language and literacy, the needs of children and adolescents, and the number of ways we can contribute. First, consider the nature of literacy. As Pamela Snow (2016) wrote, “Language is literacy is language.” Spoken and written language are reciprocal processes. That is, spoken language provides the foundation for written language learning; each feeds growth in the other; problems of reading and spoken language frequently co-occur; and instruction in one can result in growth in the other (ASHA, 2001). Second, consider the needs of children and adolescents with language disorders, spoken or written. Problems with the phonological and morphological structure of spoken language tend to be associated with problems of reading decoding and spelling encoding, which need to be treated together. Likewise, problems with understanding and expressing language using higher level vocabulary, syntax, and discourse structure tend to be experienced similarly whether language is spoken or written (Nation, 2019). Children and adolescents who experience either or both of these patterns of difficulties need inter-modality interventions to build associations across systems. Finally, consider the number of ways SLPs can contribute to meeting the needs of children and adolescents with language and literacy disorders. In addition to direct service roles, SLPs can consult with school districts about spoken-written language connections and can collaborate with teachers to integrate language intervention and language instruction using classroom-based approaches (Nelson, 2014). Additionally, SLPs can perform comparative assessments of spoken and written language (Nelson et al., 2016) that can inform inter-professional teams, including parents, about the best next steps, playing varied roles in the interventions that follow.
American Speech-Language-Hearing Association (2001). Roles and Responsibilities of Speech-Language Pathologists with Respect to Reading and Writing in Children and Adolescents. Position paper, available online at https://www.asha.org/policy/PS2001-00104/
Nation, K. (2019) Children’s reading difficulties, language, and reflections on the simple view of reading, Australian Journal of Learning Difficulties, 24(1), 47-73, doi.org/10.1080/19404158.2019.1609272
Nelson, N. W. (2014). Integrating language assessment, instruction, and intervention in an inclusive writing lab approach. In B. Arfé, J., Dockrell, & V. Berninger (Eds.), Writing development in children with hearing loss, dyslexia, or oral language problems (pp. 273-300). New York: Oxford University Press.
Nelson, N. W., Plante, E., Helm-Estabrooks, N., & Hotz, G. (2016). Test of Integrated Language and Literacy Skills (TILLS). Baltimore, MD: Brookes Publishing. https://TILLStest.com
Snow, P. (2016). Elizabeth Usher Memorial Lecture: Language is literacy is language – Positioning speech-language pathology in education policy, practice, paradigms and polemics. International Journal of Speech Language Pathology, 18(3): 216–228. doi: 10.3109/17549507.2015.1112837 Open Access at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906364/
Question: Why should speech pathologists assess pragmatics in children with language disorders?
Answer: Associate Professor Fernanda Dreux (Brazil)
Pragmatic abilities, also referred to as social communication, refers to how we use language for different reasons, how we change language depending on the listener or situation, and/or what rules we need to follow when holding conversations or telling stories ( https://www.asha.org/public/speech/development/social-communication/). Although a language assessment should include assessment of a child’s structural language skills (i.e., morphology, syntax, vocabulary), a complete language assessment should also include appraisal of the child’s pragmatic language skills, so that we get a better understanding of the association between the child’s structural language abilities and communicative competence (i.e., the ability of using language as an effective instrument to interaction with different persons in different contexts). Language disorders may relate to pragmatic abilities in different ways. Difficulties with structural language skills sometimes reduce the ability to convey meanings and intentions. When it is difficult to understand what a child says, it can be very hard to understand the intent or the feelings expressed. When a child does not understand what is said, it may be very hard for him/her to make inferences and suppositions that help build the notion of who the interlocutor is, and how to use his/her communicative abilities to express the intent, meanings or intentions.
In pragmatic language impairment, pragmatic competence may be the main difficulty. Even when the child has good abilities in grammar or vocabulary, there are difficulties with language use and the social restraints of language. These difficulties may be persistent and sometimes are associated with neurodevelopmental disorders like attention deficit and hyperactivity disorder, schizophrenia or bipolar disorder.
Swineford LB, Thurm A, Baird G, Wetherby AM & Swedo S. Social (pragmatic) communication disorder: a research review of this new DSM-5 diagnostic category. Journal of Neurodevelopmental Disorders volume 6, Article number: 41 (2014)
Lockton EL, Adams C, Collins A. Do Children with social communication disorder have explicit knowledge of pragmatic rules thet break: A comparison of conversational pragmatic ability and metapragmatic awareness. Int J Lng Commun Disord, Sept-Oct 2016, 51(5): 508 – 517 https://onlinelibrary.wiley.com/doi/epdf/10.1111/1460-6984.12227
Atypical pragmatic development. Norbury CN.In Pragmatic Development in First Language Acquisition, Danielle Matthews ed. John Benjamins Pub. Cap 19: 343-362. 2014. https://books.google.com.br/books?hl=pt-BR&lr=&id=VjTOAwAAQBAJ&oi=fnd&pg=PA343&dq=pragmatic+social+communication+disorder&ots=sTKiAk65UG&sig=_JrLZdPOGgMhpc4fWrohkRGDGtM#v=onepage&q=pragmatic%20social%20communication%20disorder&f=false
Question: Are all language disorders identifiable (or identified?) in young children or will some become evident in adolescents?
Answer: Professor Barbara Ehren (USA)
Many language disorders are found in young children. However, it is also possible that difficulty with language only become evident when the demands for language increase as children get older, especially as academic demands increase. It is important to recognize that the use of oral language for social interaction does not typically require the same level of semantic and syntactic complexity as does written language. Therefore, reading and writing may be the language processes within which some language disorders are diagnosed. Language disorders can be identified in the adolescent population that were not uncovered in earlier years, given that their schooling includes complex academic demands with higher order thinking that requires more complex language. It is critical that speech-language pathologists work with classroom teachers to identify language correlates of academic problems adolescents may be experiencing and to integrate language intervention with language sensitive classroom instruction.
Ehren, B. J. (2001). Speech-language pathologists contributing significantly to the academic success of high school students: A vision for professional growth. Topics in Language Disorders, 22 (2), 60-80.
Ehren, B. J., Lenz, B. K. & Deshler, D. D. (2014). Adolescents who struggle and 21st Century literacy. In A. Stone, E. Silliman, B. Ehren, & G. Wallach (Eds.), Handbook of language and literacy: Development and disorders (2nd Ed) (pp. 619-637). New York: Guilford.
Nippold, M. A. (2016). Language disorders in adolescents: Current needs and future directions. Seminars in Speech and Language, 37(4), 274-279.
Nippold, M. A. (2016). Later language development: School-age children, adolescents, and young adults (4th Ed.). Austin, TX: Pro-Ed.
Question: How do language disorders affect academic achievement in adolescents?
Answer: Professor Barbara Ehren (USA)
Adolescents who struggle with language have difficultly learning school subjects like history, science, mathematics, and literature. Language in aural, print and digital forms is the medium through which subject content is communicated. As ideas increase in complexity through the grades, the language to convey those ideas becomes more complex. Therefore, students who struggle with language typically fall behind in academic achievement. Further complicating the issue is that each subject area has its own literacy, that is, its own unique way of speaking and writing, not only with different vocabulary, but with different patterns of syntax and macrostructures. Hence, the added burden for children with language disorders, as they get older, is that they have to navigate disciplinary literacy. For example, in science class, the adolescent has to listen, speak, read and write like a scientist to grasp that content, then switch gears quickly when going into a history class where the literacy patterns are different.
Aram, D.M. , Ekelman, B.L. , & Nation, J.E. (1984). Preschoolers with language disorders: 10 years later. Journal of Speech and Hearing Research, 27, 232–244. https://doi.org/10.1044/jshr.2702.244
Ehren, B. J., Murza, K. A., Malani, M. D. (2012). Disciplinary literacy from a speech–language pathologist’s perspective. Topics in Language Disorders, 32 (1), 85–98.
Fang, Z. (2012). Language correlates of disciplinary literacy. Topics in Language Disorders, 32(1), 19–34.
Fang, Z. (2017). Academic language and subject area learning. In K. Hinchman & D. Appleman (Eds.), Adolescent literacy handbook of practice-based research (pp. 323-340). New York: Guilford.
Shanahan, T. & C. Shanahan (2008). Teaching disciplinary literacy to adolescents: Rethinking content area literacy. Harvard Educational Review, 78(1), 40-61.
Shanahan, T. & Shanahan, C. (2012). What is disciplinary literacy and why does it matter? Topics in Language Disorders, 32(1), 7-18.