Diagnosis Of Developmental Language Disorder Research Articles

The processing of rhythmic structures in music and prosody by children with developmental dyslexia and developmental language disorder.

Rhythm perception seems to be crucial to language development. Many studies have shown that children with developmental dyslexia and developmental language disorder have difficulties in processing rhythmic structures. In this study, we investigated the relationships between prosody and musical processing in Italian children with typical and atypical development. The tasks aimed to reproduce linguistic prosodic structures through musical sequences, offering a direct comparison between the two domains without violating the specificities of each one. About 16 Typically Developing children, 16 children with a diagnosis of Developmental Dyslexia, and 16 with a diagnosis of developmental language disorder (age 10-13years) participated in the experimental study. Three tasks were administered: an association task between a sentence and its humming version, a stress discrimination task (between couples of sounds reproducing the intonation of Italian trisyllabic words), and an association task between trisyllabic nonwords with different stress position and three-notes musical sequences with different musical stress. Children with developmental language disorder perform significantly lower than Typically Developing children on the humming test. By contrast, children with developmental dyslexia are significantly slower than TD in associating nonwords with musical sequences. Accuracy and speed in the experimental tests correlate with metaphonological, language, and word reading scores. Theoretical and clinical implications are discussed within a multidimensional model of neurodevelopmental disorders including prosodic and rhythmic skills at word and sentence level.

What Drives Educational Support for Children With Developmental Language Disorder or Autism Spectrum Disorder: Needs, or Diagnostic Category?

A central conceptual change in the Warnock report, the first type report of a UK government committee on the education of children and young people with all types of special educational needs (Department for Education and Science, 1978), was the shift from categorization of children and young people by handicap to the identification of individuals' special educational needs (SEN). However, the focus on categories has persisted. In this paper we examine the relationship between the educational provision made for children with SEN in relation to diagnostic categories as opposed to assessed needs. We draw on data from one of the studies in the Better Communication Research Programme which was commissioned by the UK government in response to the Bercow Review (2008) into provision for children and young people with speech, language and communication needs. Data were collected from 74 mainstream schools in England about the support provided to two groups of children with identified SEN (N = 157, Mean age 10;2 years): those with developmental language disorder (DLD) n = 93 and those with autism spectrum disorder (ASD) n = 64. Information was collected about school support and support by external professionals (speech and language therapists (SLTs), educational psychologists and other support services). The type and level of support provided was examined and the ways in which these differed between children with a diagnosis of DLD or ASD explored. We considered whether the support provided varied according to within child or contextual factors. In addition, change in the provision made over a 2 year time period was examined. To our knowledge this is the first study to concurrently recruit pupils with DLD and ASD from the same mainstream settings to examine differences and similarities in their profiles and the ways in which these impact on service delivery. The results demonstrated provision for children with DLD and ASD continues to be driven by diagnostic categories, and that children with ASD are significantly more likely to receive support from schools and SLTs, independent of children's language, literacy, cognitive scores and behavior. Driving amount of provision by diagnostic category limits the possibility of providing effective provision to meet the children's individual language and learning needs. This raises serious questions about the allocation of support resources and, by corollary, indicates the likelihood currently of an inequitable allocation of support to children and young people with DLD.

Assessment and diagnosis of Developmental Language Disorder: The experiences of speech and language therapists

BackgroundFor many years research and practice have noted the impact of the heterogeneous nature of Developmental Language Disorder (also known as language impairment or specific language impairment) on diagnosis and assessment. Recent research suggests the disorder is not restricted to the language domain and against this background, the challenge for the practitioner is to provide accurate assessment and effective therapy. The speech and language therapist aims to support the child and their carers to achieve the best outcomes. However, little is known about the experiences of the speech and language therapist in the assessment process, in contrast to other childhood disorders, yet their expertise is central in the assessment and diagnosis of children with language disorder.AimsThis study aimed to gain an in-depth understanding of the experiences of speech and language therapists involved in the assessment and diagnosis of children with Developmental Language Disorder including the linguistic and non-linguistic aspects of the disorder.Methods and proceduresThe qualitative study included three focus groups to provide a credible and rich description of the experiences of speech and language therapists involved in the assessment of Developmental Language Disorder. The speech and language therapists who participated in the study were recruited from different types of institution in three NHS trusts across the UK and all were directly involved in the assessment and diagnosis procedures. The lengths of speech and language therapist experience ranged from 2 years to 38 years. The data were analysed using inductive thematic analysis within a phenomenological approach.Outcomes and resultsThe analysis of the data showed three main themes relating to the speech and language therapists’ experience in assessment and diagnosis of Developmental Language Disorder. These themes were the participants’ experiences of the barriers to early referral (subthemes – parents’ misunderstanding and misconceptions of Developmental Language Disorder, bilingualism can mask Developmental Language Disorder and public lack of knowledge of support services), factors in assessment (subthemes – individual nature of impairments, choosing appropriate assessments, key indicators and identifying non-language difficulties) and the concerns over continued future support (subthemes – disadvantages with academic curriculum, disadvantages for employment, impact of Developmental Language Disorder on general life chances).Conclusions and implicationsThis study provides first-hand evidence from speech and language therapists in the assessment of children with Developmental Language Disorder, drawing together experiences from speech and language therapists from different regions. The implications are that support for early referral and improved assessment tools are needed together with greater public awareness of Developmental Language Disorder. The implications are discussed in relation to the provision of early and effective assessment and the use of current research in these procedures.

A profile of the language and cognitive skills contributing to oral inferential comprehension in young children with developmental language disorder.

Children with developmental language disorder (DLD) demonstrate poor oral inferential comprehension. Research investigating the skills that underpin oral inferential comprehension in young children with DLD is necessary in order to better understand and improve inferential comprehension in this population. To profile the language and cognitive skills that contribute to oral inferential comprehension in young children with DLD. Seventy-six children aged 5-6 years with a diagnosis of DLD were assessed on a wide range of language and cognitive measures. Oral inferential comprehension of narrative was the primary outcome measure. Narrative macrostructure and microstructure, literal comprehension, vocabulary, phonological loop, and theory of mind were significant predictors of inferential comprehension in bivariate analyses. However, multivariate regression analysis indicated that only narrative retell macrostructure and theory of mind contributed a significant amount of unique variance to inferential comprehension. This study profiled the skills contributing to oral inferential comprehension in young children with DLD, to support the clinical and theoretical understanding of the ability in this population. The findings have implications for future intervention studies.

Why is it so hard to reach agreement on terminology? The case of developmental language disorder (DLD).

A recent project entitled CATALISE used the Delphi method to reach a consensus on terminology for unexplained language problems in children. ‘Developmental language disorder’ (DLD) was the term agreed by a panel of 57 experts. Here I reflect on points of difficulty that arose when attempting to reach a consensus, using qualitative information from comments made by panel members to illustrate the kinds of argument used. One issue of debate was the use of labels, in particular the term ‘disorder’, which was seen as having both pros and cons. The potential for labels to stigmatize or create low expectations was a particular concern. However, labels could also ensure language problems were not trivialized and could help avoid stigma by providing an explanation for behaviours that might otherwise meet with disapproval. Further debate surrounded issues of how best to identify cases of disorder. Although it was agreed there should be a focus on cases with a poor prognosis, it was recognized that our knowledge of factors related to prognosis was still incomplete. Furthermore, there was a tension between use of standardized tests, which allow for a relatively objective and reliable assessment of language, and more qualitative observations, which can capture functional aspects of communication that are not always picked up on formal assessment. Debate also surrounded the issue of the relationship between DLD and other conditions. Some favoured drawing a distinction between DLD and language disorders associated with other conditions, and others regarded such distinctions as unnecessary. We concluded that it was misleading to assume co‐occurring conditions were causes of language disorder, but it was helpful to distinguish DLD from cases of language disorder associated with ‘differentiating conditions’ that had a known or likely biomedical origin, including brain injury, sensorineural hearing loss, genetic syndromes, intellectual disability and autism spectrum disorder. Furthermore, DLD could co‐occur with milder neurodevelopmental disorders that did not have a clear biomedical aetiology. Normal‐range non‐verbal IQ has traditionally been incorporated in the diagnosis of DLD, but this was rejected as unsupported by evidence. DLD is a category that has utility in identifying children who would benefit from speech–language therapy services, but it should not be thought of as a well‐defined condition. DLD has a multifactorial aetiology, is heterogeneous in terms of language features and overlaps with other neurodevelopmental disorders. Our notions of DLD are likely to be refined by further research into aetiology, associated characteristics and intervention effectiveness.

Cognitive deficits and developmental language disorders in patients with malformations of cortical development

It is generally accepted that in patients with malformations of cortical development (MCD) the severity of the neurologic and developmental deficiencies is determined by the etiology, localization, and extent of the malformation, as well as by the severity of the associated epilepsy syndrome. Apart from two detailed reports on the occurrence of developmental dyslexia in patients with periventricular nodular heterotopia (Chang et al., 2005, 2007), precise neuropsychological information is available mainly in patients with polymicrogyria (PMG). A first set of studies has addressed the neuropsychological profiles of patients with bilateral perisylvian PMG. In a study of 17 patients with bilateral perisylvian PMG (Montenegro et al., 2001), 7 had bilateral perisylvian PMG limited to the posterior parietal areas, sparing the anterior two-thirds of the sylvian fissure, and 10 had diffuse bilateral perisylvian PMG. In the first group, neurologic examination was normal, seizures were absent, and two had mild dysarthria later in life. In the second group, all had pseudobulbar palsy with or without motor involvement, and seizures were present in four. A second study in 14 patients with bilateral perisylvian PMG (Jansen et al., 2005) showed that exceptionally low intelligence (Full IQ scores <70) was present in <30% of patients, memory abilities were average or low average, frontal lobe function was relatively well preserved, and both receptive and expressive language skills were severely impaired. These findings suggested that the observed cognitive profiles were related to specific areas of cortical dysfunction and not just to global brain dysfunction. This conclusion was supported by a study of six children with bilateral perisylvian PMG (Saletti et al., 2007) in whom mental retardation was related to the extent of cortical malformation, lexical comprehension and verbal production were more compromised than expected from nonverbal intellectual abilities, and lack of verbal language was not compensated by the use of referential gestures. These results suggested that compromised verbal and gestural communication in bilateral perisylvian PMG is not due simply to mental retardation and/or dysarthria but also to dysfunction of the perisylvian areas concerned with the totality of language processing. Care should be taken not to label patients with bilateral perisylvian PMG as mentally retarded, unless proven by detailed neuropsychological studies. Magnetic resonance imaging (MRI) facilitates early diagnosis, which should result in planning for appropriate education, and allow these individuals to develop to their maximum potential. A second set of studies consisted of patients with a diagnosis of developmental language disorder in whom imaging studies had been performed. Brain MRIs were carried out on a 2T scan and included multiplanar reconstructions

Disability pensions in individuals diagnosed with a developmental language disorder as children

Knowledge is limited regarding the association between developmental language disorder (DLD) and disability pension. The objective of this cross-sectional study was to estimate the prevalence and grounds for granting disability pensions in a group of individuals diagnosed with a DLD as children. Four-hundred and sixty-nine individuals with a DLD (consecutively assessed in the same clinic during a period of 10 years) and 2345 controls from the general population were screened through the nationwide Danish Register of Disability Pensions, covering a study period of 11 years. The results show that individuals with DLD had significantly higher rates of disability pensions granted compared with the control group: 11.3% versus 2% (<em>p</em>&lt;0.0001; odds ratio = 6.2; 95% confidence interval: 4.15–9.35). Mental disorder was the most frequent reason given for granting a disability pension and accounted for 86.8% of cases in the DLD group and 72.3% in the comparison group. The variable degree of expressive language disorder was related to the relative risk of being granted a disability pension, with the highest level apparent in the mild scoring group at assessment in childhood. Our results show that a diagnosis of DLD in childhood constitutes a strong predictor of disability pension in early adult life, thus emphasizing an urgent need for more knowledge about individual and contextual risk factors.

A longitudinal study of autism spectrum disorders in individuals diagnosed with a developmental language disorder as children

A number of studies have shown that the diagnosis of developmental language disorder (DLD) can be unstable over time, such that young children with a diagnosis of DLD may show symptoms more characteristics of autism spectrum disorder (ASD) at a later date. To estimate the types and prevalence of ASD 469 individuals with a DLD, consecutively assessed in the same clinic during a period of 10 years, and 2345 controls from the general population were screened for ASD through the nationwide Danish Psychiatric Central Register (DPCR). The mean length of observation was 34.7 years, and the mean age at follow-up 35.8 (range: 28.3-46.7) years. At follow-up, 10 (2.1%) in the DLD group and two (0.09%) in the comparison group were known in the DPCR with a diagnosis of any ASD (P < 0.0001; odds ratio = 25.5; 95% confidence interval 5.5-116.9). Our results provide additional support to the notion that DLD is a marker of increased vulnerability to the development of ASD.

Characterization of language and reading skills in familial polymicrogyria

Polymicrogyria (PMG) is a malformation of cortical development characterized by an excessive number of small gyri and abnormal cortical lamination, giving the cortical surface an irregular and gross appearance. The severity of clinical manifestations correlates with the extent of cortical involvement. The objective of the present study was to describe three families with linguistic features of developmental language disorder and reading impairment, and to establish a neuroanatomic correlation through neuroimaging. Subjects have been submitted to a comprehensive protocol including psychological assessment, language evaluation, neurological examination, and neuroimaging investigation. In our families, children usually had the diagnosis of developmental language disorder while adults had the diagnosis of reading impairment. MRI showed perisylvian polymicrogyria in several subjects of each family. Our data support the idea that there is a co-occurrence of developmental language disorder and reading impairment and both conditions may be associated with polymicrogyria.

Language development among the siblings of children with autistic spectrum disorder

Language development in 32 preschool siblings (aged 2-6 years) of children with diagnosed autistic spectrum disorder (ASD) was compared with that of a control group of 28 typical preschool children. Groups were matched by siblings' age, gender, maternal educational level and family income. The mean ages of the siblings group and the control group were 4.2 and 4.4 years. Eight of the siblings had delayed language development, of whom three received a diagnosis of developmental language disorder (DLD) and one of ASD. The sibling with ASD and two of those with DLD were excluded; the remaining 29 siblings and the controls were administered the Stanford-Binet IV. Verbal IQs of siblings were not significantly different from the control group. Siblings of children with ASD associated with intellectual impairment ('mental retardation' (MR) in Thailand) had significantly lower verbal IQ scores than siblings of children with ASD but without MR.