Ten questions about terminology for children with unexplained language problems.

D. V. M. Bishop

doi:10.1111/1460-6984.12101

Abstract

BackgroundIn domains other than language, there is fairly consistent diagnostic terminology to refer to children's developmental difficulties. For instance, the terms ‘dyslexia’, ‘attention deficit hyperactivity disorder’ and ‘autistic spectrum disorder’ are used for difficulties with reading, attention or social cognition, respectively. There is no agreed label, however, for children with unexplained language problems.AimsTo consider whether we need labels for unexplained language problems in children, and if so, what terminology is appropriate.Main ContributionThere are both advantages and disadvantages to labels, but they are important to ensure children receive services, and to increase our knowledge of the nature and causes of such problems. A survey of labels in current use found 132 different terms, 33 of which had 600 or more returns on Google Scholar between 1994 and 2013. Many of these labels were too general to be useful. Of the remainder, the term ‘specific language impairment’ was the most commonly used.ConclusionsThe current mayhem in diagnostic labels is unsustainable; it causes confusion and impedes research progress and access to appropriate services. We need to achieve consensus on diagnostic criteria and terminology. The DSM-5 term ‘language disorder’ is problematic because it identifies too wide a range of conditions on an internet search. One solution is to retain specific language impairment, with the understanding that ‘specific’ means idiopathic (i.e., of unknown origin) rather than implying there are no other problems beyond language. Other options are the terms ‘primary language impairment’, ‘developmental language disorder’ or ‘language learning impairment’.

Highlights

In English-speaking children, a failure to use aspects of grammatical morphology reliably by 5 years of age can be used as an indicator of language impairment—a view supported by a recent study by Redmond et al (2011)
Autism spectrum disorder (ASD) is of particular interest, because traditional diagnostic criteria exclude a diagnosis of specific language impairment (SLI) when ASD is present, yet it is clear that a subset of children with ASD have language difficulties that are similar to those seen in SLI (TagerFlusberg and Caronna 2007)
Norbury (2014) has pointed out a number of problems with this solution: it treats SLI and social communication (pragmatic) disorder (SCD) as different conditions, though often there are overlapping impairments in the two groups; it bases diagnosis on aspects of social communication for which reliable and valid assessments are lacking; and there is a risk that children may end up with no suitable intervention if no professional group feels responsible for meeting their needs

Summary

Introduction

He is beginning to be reluctant to go to school, except on days when he has art lessons, which he loves. His parents, concerned to see him so miserable, have arranged a private assessment with a psychologist, who diagnoses specific language impairment (SLI) and dyslexia She explains that George has a nonverbal IQ of 95, within normal limits, but his vocabulary and comprehension levels are lower, with scaled score equivalents of 80, and his reading ability is at a 6-year-old level. The vexed issue of what terminology should be adopted will emerge in the course of this article

Should we be concerned about children’s language problems?

Should we abandon diagnostic labels?

Is a medical model appropriate for unexplained language problems in children?

What are appropriate criteria for identifying children’s language problems?

Does it make sense to focus on ‘specific’ problems with language?

Are language problems distinct from other neurodevelopmental disorders?

What labels have been used for unexplained language problems?

What are the consequences of the lack of agreed terminology?

10. What terminology should we adopt?

Findings

Main text