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Developmental language disorder
Developmental language disorder
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Developmental language disorder (DLD) is identified when a child has problems with language development that continue into school age and beyond. The language problems have a significant impact on everyday social interactions or educational progress, and occur in the absence of autism spectrum disorder, intellectual disability or a known biomedical condition. The most obvious problems are difficulties in using words and sentences to express meanings, but for many children, understanding of language (receptive language) is also a challenge, although this may not be evident unless the child is given a formal assessment.

Classification

Terminology

The term developmental language disorder (DLD) was endorsed in a consensus study involving a panel of experts (CATALISE Consortium) in 2017.^[1] The study was conducted in response to concerns that a wide range of terminology was used in this area, with the consequence that there was poor communication, lack of public recognition, and in some cases children were denied access to services. Developmental language disorder is a subset of language disorder, which is itself a subset of the broader category of speech, language and communication needs (SLCN).

The terminology for children’s language disorders has been extremely wide-ranging and confusing, with many labels that have overlapping but not necessarily identical meanings.^[2] In part this confusion reflected uncertainty about the boundaries of DLD, and the existence of different subtypes. Historically, the terms ‘’developmental dysphasia’’ or ‘’developmental aphasia’’ were used to describe children with the clinical picture of DLD.^[3] These terms have, however, largely been abandoned, as they suggest parallels with adult acquired aphasia. This is misleading, as DLD is not caused by brain damage.^[4]

Although the term DLD has been used for many years, it has been less common than the term specific language impairment (SLI),^[2] which has been widely adopted, especially in North America.^[5] The definition of SLI overlaps with DLD, but was rejected by the CATALISE panel because it was seen as overly restrictive in implying that the child had relatively pure problems with language in the absence of any other impairments. Children with such selective problems are relatively rare, and there is no evidence that they respond differently to intervention, or have different causal factors, from other children with language problems.^[6]

In the UK education system the term speech, language and communication needs (SLCN) is widely used, but this is far broader than DLD, and includes children with speech, language and social communication difficulties arising from a wide range of causes.^[7]

The question of whether to refer to children's language problems as ‘disorder’ was a topic of debate among the CATALISE consortium, but the conclusion was that ‘disorder’ conveyed the serious nature and potential consequences of persistent language deficits. It is also parallel with other neurodevelopmental conditions and consistent with diagnostic frameworks such as DSM-5 and ICD-11.^[1] Where there are milder or more transient difficulties, language difficulties may be a more appropriate term.

Types of language difficulty

DLD can affect a range of areas of language and the degree of impairment in different areas of language can vary from child to child.^[8] However, although there have been attempts to define different subtypes, these have not generally resulted in robust categories.^[9] The recommendation of the CATALISE panel was that the specific areas of impairment should be assessed and documented for individual children, while recognizing that different children might have different combinations of problems. The areas which can be affected are:

Grammar – This involves the ability to combine words into grammatically correct sentences (syntax) and to combine parts of words together (morphology) such as adding grammatical endings to verbs like -ing or -ed or to add prefixes and suffixes like dis- or -ation. For instance, a child may say 'me jump here', instead of 'I jumped here'.^[10] Comprehension of sentences can also be affected. For instance, there may be difficulty understanding meaning expressed by word order, and so confusion about what is blue in a sentence like 'the pencil on the shoe is blue',^[11] and a tendency to use general knowledge rather than linguistic cues to meaning,^[12] or problems in interpreting grammatical markers of number or tense.^[13]
Semantics – This refers to children’s ability to understand the meaning of words and how meanings are expressed by combining words together. Children with DLD often have limited vocabulary and may make heavy use of a small set of words with rather general meanings.^[14] As children with developmental language disorder get older, they may have a hard time understanding that some words have multiple meanings, for example the word “cold,” which can mean a low temperature, a sickness, or being unfriendly.^[15]^[16]
Word finding – Children with word finding difficulties may know a word, but have difficulty accessing it for production^[17] – similar to the tip of the tongue phenomenon.
Pragmatics – Pragmatics refers to the ability to select the appropriate message, or interpret what others say, in relation to context. Pragmatic difficulties can give an impression of oddity, with the content of language not fitting the environmental or social context; comprehension may be over-literal; the child may chatter incessantly, be poor at turn-taking in conversation and maintaining a topic^[18]
Discourse – Discourse refers to a level of organization of language beyond the sentence. Child with limitations in this domain may have limited ability to tell a story or describe a set of events in a logical sequence^[19]
Verbal memory and learning – Problems with remembering words or sentences can affect both the learning of new vocabulary,^[20] and the understanding of long or complex sentences.^[21] Young children with DLD may say their first words later than other children. It may also take children with DLD longer to learn and remember novel words.^[15]

Phonology – Phonology is the branch of linguistics concerned with the way sounds are combined together in words. Children with difficulties with phonology may fail to distinguish between certain speech sounds, such as 't' and 'k', so that 'cake' is produced as 'tate'. Such difficulties are not unusual as part of typical development in toddlers, but they would usually resolve by the time children are 4–5 years old.^[22] Difficulties with producing some speech sounds accurately may reduce intelligibility of speech.^[23] In addition, more subtle difficulties in recognising specific sounds in words (phonological awareness) can lead to literacy difficulties.^[24]

Relationship with speech disorders

Speech is the act of articulating sounds, and this can be impaired for all kinds of reasons – a structural problem such as cleft lip and cleft palate, a neurological problem affecting motor control of the speech apparatus dysarthria, or inability to perceive distinctions between sounds because of hearing loss. Some distortions of speech sounds, such as a lisp, are commonly seen in young children. These misarticulations should not be confused with language problems, which involve the ability to select and combine linguistic elements to express meanings, and the ability to comprehend meanings.

Although speech disorders can be distinguished from language disorders, they can also co-occur.^[25] When a child fails to produce distinctions between speech sounds for no obvious reason, this is typically regarded as a language problem affecting the learning of phonological contrasts. The classification of and terminology for disorders of speech sound production is a subject of considerable debate.^[26] In practice, even for those with specialist skills, it is not always easy to distinguish between phonological disorders and other types of speech production problem. Speech sound disorder (SSD) is any problem with speech production arising from any cause.^[27]

Speech sound disorders of unknown cause that are not accompanied by other language problems are a relatively common reason for young children to be referred to speech-language therapy (speech-language pathology).^[28] These often resolve by around 4–5 years of age with specialist intervention,^[29] and so would not meet criteria for DLD. Where such problems continue beyond five years of age, they are usually accompanied by problems in broader language domains and have a poorer prognosis,^[30] so a diagnosis of DLD with SSD is then appropriate.

Relationship with other neurodevelopmental disorders

DLD often co-occurs with milder neurodevelopmental disorders of unknown origin, such as attention-deficit hyperactivity disorder, developmental dyslexia or developmental co-ordination disorder.^[6] These do not preclude a diagnosis of DLD, but should be noted as co-occurring conditions.

Risk factors

It is generally accepted that DLD is strongly influenced by genetic factors.^[31] The best evidence comes from the twin study method. Two twins growing up together are exposed to the same home environment, yet may differ radically in their language skills. Such different outcomes are, however, much more common in fraternal (non-identical) twins, who are genetically different. Identical twins share the same genes and tend to be much more similar in language ability. There can be some variation in the severity and persistence of DLD in identical twins, indicating that non-genetic factors affect the course of disorder, but it is unusual to find a child with DLD who has an identical twin with typical language.^[32]

There was considerable excitement when a large, multigenerational family with a high rate of DLD were found to have a mutation of the FOXP2 gene just in the affected family members.^[33] However, subsequent studies have found that, though DLD runs in families, it is not usually caused by a mutation in FOXP2 or another specific gene.^[34] Current evidence suggests that there are many different genes that can influence language learning, and DLD results when a child inherits a particularly detrimental combination of risk factors, each of which may have only a small effect.^[31] Nevertheless, study of the mode of action of the FOXP2 gene has helped identify other common genetic variants involved in the same neural pathways that may play a part in causing DLD.^[35]

Language disorders are associated with aspects of home environment, and it is often assumed that this is a causal link, with poor language stimulation leading to weak language skills. Twin studies, however, show that two children in the same home environment can have very different language outcomes, suggesting we should consider other explanations for the link. Children with DLD often grow up into adults who have relatively low educational attainments,^[36] and their children may share a genetic risk for language disorder.^[2]

One non-genetic factor that is known to have a specific impact on language development is being a younger sibling in a large family.^[37]

Associated factors

It has long been noted that males are more affected by DLD than females, with a sex ratio of affected males: females around 3 or 4:1.^[38] However, the sex difference is much less striking in epidemiological samples, suggesting that similar problems may exist in females but are less likely to be detected.^[39] The reason for the sex difference is not well understood.

Poor motor skills are commonly found in children with DLD.^[40] Standardized measures of motor ability confirm that children with DLD exhibit deficits in fine and gross motor skill, both simple and complex. These difficulties also extend to speech-motor ability, particularly with the control of their articulatory movements. Children with DLD have difficulty with motor sequence learning and may show deficits in other procedural motor processes as well.^[41]

Brain scans do not usually reveal any obvious abnormalities in children with DLD, although quantitative comparisons have found differences in brain size or relative proportions of white or grey matter in specific regions. In some cases, unusual brain gyri are found. To date, no consistent 'neural signature' for DLD has been found, although some studies have noted evidence for involvement of subcortical systems.^[42] Differences in the brains of children with DLD vs typically developing children are subtle and may overlap with atypical patterns seen in other neurodevelopmental disorders.^[43]

Diagnosis

DLD is defined purely in behavioural terms: there is no biological test. There are three points that need to be met for a diagnosis of DLD:^[1]

The child has language difficulties that create obstacles to communication or learning in everyday life,
The child's language problems are unlikely to resolve by five years of age, and
The problems are not associated with a known biomedical condition such as brain injury, neurodegenerative conditions, genetic conditions or chromosome disorders such as Down syndrome, sensorineural hearing loss, or autism spectrum disorder or intellectual disability.

For research and epidemiological purposes, specific cutoffs on language assessments have been used to document the first criterion. Tomblin et al.^[44] proposed the EpiSLI criterion, based on five composite scores representing performance in three domains of language (vocabulary, grammar, and narration) and two modalities (comprehension and production). Children scoring in the lowest 10% on two or more composite scores are identified as having language disorder.

The second criterion, persistence of language problems, can be difficult to judge in a young child, but longitudinal studies have shown that difficulties are less likely to resolve for children who have poor language comprehension, rather than difficulties confined to expressive language.^[1] In addition, children with isolated difficulties in just one of the areas noted under 'subtypes' tend to make better progress than those whose language is impaired in several areas.^[30]

The third criterion specifies that DLD is used for children whose language disorder is not part of another biomedical condition, such as a genetic syndrome, a sensorineural hearing loss, neurological disease, autism spectrum disorder or intellectual disability – these were termed 'differentiating conditions' by the CATALISE panel.^[1] Language disorders occurring with these conditions need to be assessed and children offered appropriate intervention, but a terminological distinction is made so that these cases would be diagnosed as language disorder associated with the main diagnosis being specified: e.g. "language disorder associated with autism spectrum disorder." The reasoning behind these diagnostic distinctions is discussed further by Bishop (2017).^[45]

Benchmarks for children with Developmental Language Disorder

Common red flags at one year of age

No reaction to sound
No babbling
Difficulty feeding
No imitation
Limited use of gestures

At two years of age

Makes minimal attempts to communicate with gestures or words
Has not spoken their first words
Difficulty following simple directions
Inconsistent response to "no"

At three years of age

Limited use of speech
Incomprehensible speech
Limited understanding of simple questions
Difficulty naming objects
Frustration related to communication

At four years of age

Uses only 3 word phrases
Speech is not understandable to parents
Takes a long time to understand others
Difficulty asking questions and finding words to express thoughts

At five years of age

Speaks only in simple sentences
Speech is not understandable to teachers
Difficulty answering questions
Difficulty with complex directions
Difficulty telling stories
Difficulty with peer interactions ^[46]

Assessment

Assessment will usually include an interview with the child’s caregiver, observation of the child in an unstructured setting, a hearing test, and standardized tests of language.^[47] There is a wide range of language assessments in English. Some are restricted for use by experts in speech-language pathology: speech and language therapists (SaLTs/SLTs) in the UK, speech-language pathologists (SLPs) in the US and Australia. A commonly used test battery for diagnosis of DLD is the Clinical Evaluation of Language Fundamentals (CELF). Assessments that can be completed by a parent or teacher can be useful to identify children who may require more in-depth evaluation. The Children’s Communication Checklist (CCC–2) is a parent questionnaire suitable for assessing everyday use of language in children aged four years and above who can speak in sentences. Informal assessments, such as language samples, are often used by speech-language therapists/pathologists to complement formal testing and give an indication of the child's language in a more naturalistic context. A language sample may be of a conversation or narrative retell. In a narrative language sample, an adult may tell the child a story using a wordless picture book (e.g. Frog Where Are You?, Mayer, 1969), then ask the child to use the pictures and tell the story back. Language samples can be transcribed using computer software such as the Systematic Analysis of Language Software, and then analyzed for a range of features: e.g., the grammatical complexity of the child's utterances, whether the child introduces characters to their story or jumps right in, whether the events follow a logical order, and whether the narrative includes a main idea or theme and supporting details.

Treatment

Treatment is usually carried out by speech and language therapists/pathologists, who use a wide range of techniques to stimulate language learning.^[48] In the past, there was a vogue for drilling children in grammatical exercises, using imitation and elicitation, but such methods fell into disuse when it became apparent that there was little generalisation to everyday situations. Contemporary approaches to enhancing development of language structure, for younger children at least, are more likely to adopt 'milieu' methods, in which the intervention is interwoven into natural episodes of communication, and the therapist builds on the child's utterances, rather than dictating what will be talked about. Interventions for older children, may be more explicit, telling the children what areas are being targeted and giving explanations regarding the rules and structures they are learning, often with visual supports.^[49]^[50]

In addition, there has been a move away from a focus solely on grammar and phonology toward interventions that develop children's social use of language, often working in small groups that may include typically developing as well as language-impaired peers.^[51]

Another way in contemporary remediation differ from the past is that parents are more likely to be directly involved, but this approach is largely used with preschool children, rather than those whose problems persist into school age.^[52]^[53]

For school-aged children, teachers are increasingly involved in intervention, either in collaboration with speech and language therapists/pathologists, or as the main agents of delivery of the intervention. Evidence for the benefits of a collaborative approach is emerging,^[54] but the benefits of asking education staff to be the main deliverers of SLT intervention (the “consultative” approach) are unclear.^[55] When SLT intervention is delivered indirectly by trained SLT assistants, however, there are indications that this can be effective.^[56]

In this field, randomized controlled trial methodology has not been widely used, and this makes it difficult to assess clinical efficacy with confidence. Children's language will tend to improve over time, and without controlled studies, it can be hard to know how much of observed change is down to a specific treatment. There is, however, increasing evidence that direct 1:1 intervention with an SLT/P can be effective for improving vocabulary and expressive language.^[57] There have been few studies of interventions that target receptive language,^[58] though some positive outcomes have been reported.^[59]^[60]^[61]

How to help a child with Developmental Language Disorder

Talk to the child often to help them learn new words.
Read to them every day. Point out words you see.
Point to signs in the grocery store, at school, and outside.
Speak to the child in the language you know best.
Listen and answer when the child talks.
Get the child to ask you questions.
Give the child time to answer questions.
Keep them in school. Children who are school-refusers have poorer language skills overall, and a higher incidence of language impairments^[62]

Outcome

Longitudinal studies indicate that problems are largely resolved by five years of age in around 40% of four-year-olds with early language delays who have no other presenting risk factors.^[30] However, for children who still have significant language difficulties at school entry, reading problems are common, even for children who receive specialist help,^[63] and educational attainments are typically poor.^[64] Poor outcomes are most common in cases where comprehension as well as expressive language is affected.^[65] There is also evidence that scores on tests of nonverbal ability of children with DLD decrease over the course of development.^[66]

DLD is associated with an elevated risk of social, emotional and mental health concerns.^[67] For instance, in a UK survey, 64% of a sample of 11-year-olds with DLD scored above a clinical threshold on a questionnaire for psychiatric difficulties, and 36% were regularly bullied, compared with 12% of comparison children.^[68] In the longer-term, studies of adult outcomes of children with DLD have found elevated rates of unemployment, social isolation and psychiatric disorder among those with early comprehension difficulties.^[69] However, better outcomes are found for children who have milder difficulties and do not require special educational provision.^[70]

Prevalence

Epidemiological surveys, in the US^[71] and the UK^[39] converge in estimating the prevalence of DLD in five-year-olds at around 7%. Therefore, the prevalence is one in every 15 children. By these statistics, in a classroom of 30 students, 2 would have DLD.^[15] In research by Tomblin et al. prevalence of [DLD] in racial/ethnic groups was highest in Native Americans, with African Americans being the next highest, followed by Hispanics, and then Whites.^[72] No students of Asian descent presented with [DLD]; however, other research does indicate that [DLD] is present in children of Asian descent).

Research

Much research has focused on trying to identify what makes language learning so hard for some children.^[73] A major divide is between theories that attribute the difficulties to a low-level problem with auditory temporal processing, and those that propose there is a deficit in a specialised language-learning system.^[74]^[75] Other accounts emphasise deficits in specific aspects of learning and memory.^[76]^[77] It can be difficult to choose between theories because they do not always make distinctive predictions, and there is considerable heterogeneity among children with DLD. It has also been suggested that DLD may only arise when more than one underlying deficit is present.^[78]

Developmental learning disorder in adults

Relatively little research has been conducted to test the outcomes of DLD in adults. In a study comparing 17 men with DLD to their non language disordered siblings, researchers found that The DLD men had normal intelligence with higher performance IQ than verbal IQ. The participants still exhibited a severe and persisting language disorder, severe literacy impairments and significant deficits in theory of mind and phonological processing. Within the DLD cohort higher childhood intelligence and language were associated with superior cognitive and language ability at final adult outcome. In their mid-thirties, the DLD cohort had significantly worse social adaptation (with prolonged unemployment and a paucity of close friendships and love relationships) compared with both their siblings and NCDS controls. Self-reports showed a higher rate of schizotypal features but not affective disorder. Four DLD adults had serious mental health problems (two had developed schizophrenia).^[79]

References

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^ ^a ^b Norbury, Courtenay Frazier; Gooch, Debbie; Wray, Charlotte; Baird, Gillian; Charman, Tony; Simonoff, Emily; Vamvakas, George; Pickles, Andrew (November 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. doi:10.1111/jcpp.12573.
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^ Bishop, Dorothy V. M. (November 2017). "Why is it so hard to reach agreement on terminology? The case of developmental language disorder (DLD)". International Journal of Language & Communication Disorders. 52 (6): 671–680. doi:10.1111/1460-6984.12335. PMID 28714100.
^ Identifying Red Flags for Developmental Language Disorder. (n.d.). Retrieved from https://www.boystownhospital.org/knowledge-center/red-flags-developmental-language-disorder.
^ Paul, R. (2006). Language Disorders from Infancy through Adolescence: Assessment and Intervention, 3rd Edition. St. Louis: Mosby-Year Book.^{[page needed]}
^ Roth, F. P., & Worthington, C. K. (2010). Treatment resource manual for speech-language pathology, 4th edition. San Diego: Singular Publishing.^{[page needed]}
^ Ebbels, Susan (25 July 2016). "Teaching grammar to school-aged children with specific language impairment using Shape Coding". Child Language Teaching and Therapy. 23 (1): 67–93. doi:10.1191/0265659007072143.
^ Bryan, A., Colourful Semantics., in Language disorders in children and adults: psycholinguistic approaches to therapy., S. Chiat, J. Law, and J. Marshall, Editors. 1997, Whurr: London^{[page needed]}
^ Gallagher, Tanya M. (1996). "Social-interactional approaches to child language intervention". In Beitchman, Joseph H.; Cohen, Nancy J.; Konstantareas, M. Mary; Tannock, Rosemary (eds.). Language, Learning, and Behavior Disorders: Developmental, Biological, and Clinical Perspectives. Cambridge University Press. pp. 418–435. ISBN 978-0-521-47229-6. {{cite book}}: External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
^ "The Effectiveness of Parent-Implemented Language Interventions: A Meta-Analysis". American Journal of Speech-Language Pathology. 20 (3): 180–199. 1 August 2011. doi:10.1044/1058-0360(2011/10-0055).
^ Tosh, Rachel; Arnott, Wendy; Scarinci, Nerina (May 2017). "Parent-implemented home therapy programmes for speech and language: a systematic review". International Journal of Language & Communication Disorders. 52 (3): 253–269. doi:10.1111/1460-6984.12280.
^ Archibald, Lisa MD (January 2017). "SLP-educator classroom collaboration: A review to inform reason-based practice". Autism & Developmental Language Impairments. 2. doi:10.1177/2396941516680369.
^ McCartney, Elspeth; Boyle, James; Ellis, Sue; Bannatyne, Susan; Turnbull, Mary (26 March 2010). "Indirect language therapy for children with persistent language impairment in mainstream primary schools: outcomes from a cohort intervention". International Journal of Language & Communication Disorders. doi:10.3109/13682820903560302.
^ McCartney, Elspeth; Boyle, James; Ellis, Sue; Bannatyne, Susan; Turnbull, Mary (26 March 2010). "Indirect language therapy for children with persistent language impairment in mainstream primary schools: outcomes from a cohort intervention". International Journal of Language & Communication Disorders. doi:10.3109/13682820903560302.
^ Law, James; Garrett, Zoe; Nye, Chad (August 2004). "The Efficacy of Treatment for Children With Developmental Speech and Language Delay/Disorder". Journal of Speech, Language, and Hearing Research. 47 (4): 924–943. doi:10.1044/1092-4388(2004/069). PMID 15324296.
^ Boyle, James; McCartney, Elspeth; O'Hare, Anne; Law, James (November 2010). "Intervention for mixed receptive-expressive language impairment: a review". Developmental Medicine & Child Neurology. 52 (11): 994–999. doi:10.1111/j.1469-8749.2010.03750.x.
^ Ebbels, Susan (9 December 2013). "Effectiveness of intervention for grammar in school-aged children with primary language impairments: A review of the evidence". Child Language Teaching and Therapy. 30 (1): 7–40. doi:10.1177/0265659013512321.
^ Ebbels, Susan H.; Marić, Nataša; Murphy, Aoife; Turner, Gail (January 2014). "Improving comprehension in adolescents with severe receptive language impairments: a randomized control trial of intervention for coordinating conjunctions". International Journal of Language & Communication Disorders. 49 (1): 30–48. doi:10.1111/1460-6984.12047.
^ Ebbels, Susan H.; Wright, Lisa; Brockbank, Sally; Godfrey, Caroline; Harris, Catherine; Leniston, Hannah; Neary, Kate; Nicoll, Hilary; Nicoll, Lucy; Scott, Jackie; Marić, Nataša (July 2017). "Effectiveness of 1:1 speech and language therapy for older children with (developmental) language disorder". International Journal of Language & Communication Disorders. 52 (4): 528–539. doi:10.1111/1460-6984.12297.
^ Johnson, Carla J.; Beitchman, Joseph H.; Brownlie, E. B. (February 2010). "Twenty-Year Follow-Up of Children With and Without Speech-Language Impairments: Family, Educational, Occupational, and Quality of Life Outcomes". American Journal of Speech-Language Pathology. 19 (1): 51–65. doi:10.1044/1058-0360(2009/08-0083).
^ "A Longitudinal Investigation of Reading Outcomes in Children With Language Impairments". Journal of Speech, Language, and Hearing Research. 45 (6): 1142–1157. 1 December 2002. doi:10.1044/1092-4388(2002/093).
^ Snowling, Margaret J.; Adams, John W.; Bishop, D. V. M.; Stothard, Susan E. (2001). "Educational attainments of school leavers with a preschool history of speech-language impairments". International Journal of Language & Communication Disorders. 36 (2): 173–183. doi:10.1080/13682820120976.
^ Simkin, Zoë; Conti-Ramsden, Gina (26 July 2016). "Evidence of reading difficulty in subgroups of children with specific language impairment". Child Language Teaching and Therapy. 22 (3): 315–331. doi:10.1191/0265659006ct310xx.
^ Botting, Nicola (March 2005). "Non-verbal cognitive development and language impairment". Journal of Child Psychology and Psychiatry. 46 (3): 317–326. doi:10.1111/j.1469-7610.2004.00355.x.
^ Cohen, Nancy (2001). Language impairment and psychopathology in infants, children, and adolescents. Thousand Oaks: Sage Publications. ISBN 0-7619-2025-0. OCLC 45749780.
^ "Social Difficulties and Victimization in Children With SLI at 11 Years of Age". Journal of Speech, Language, and Hearing Research. 47 (1): 145–161. 1 February 2004. doi:10.1044/1092-4388(2004/013).
^ Clegg, J.; Hollis, C.; Mawhood, L.; Rutter, M. (February 2005). "Developmental language disorders - a follow-up in later adult life. Cognitive, language and psychosocial outcomes". Journal of Child Psychology and Psychiatry. 46 (2): 128–149. doi:10.1111/j.1469-7610.2004.00342.x.
^ Snowling, Margaret J.; Bishop, D.V.M.; Stothard, Susan E.; Chipchase, Barry; Kaplan, Carole (9 June 2006). "Psychosocial outcomes at 15 years of children with a preschool history of speech-language impairment". Journal of Child Psychology and Psychiatry. 47 (8): 759–765. doi:10.1111/j.1469-7610.2006.01631.x.
^ "Prevalence of Specific Language Impairment in Kindergarten Children". Journal of Speech, Language, and Hearing Research. 40 (6): 1245–1260. 1 December 1997. doi:10.1044/jslhr.4006.1245.
^ Tomblin, J. Bruce; Records, Nancy L.; Buckwalter, Paula; Zhang, Xuyang; Smith, Elaine; O’Brien, Marlea (December 1997). "Prevalence of Specific Language Impairment in Kindergarten Children". Journal of speech, language, and hearing research. 40 (6): 1245–1260. PMC 5075245.
^ Bishop, D. V. M. (1997). Uncommon Understanding: Development and Disorders of Language Comprehension in Children. Hove: Psychology Press.
^ "Specific Language Impairment as a Period of Extended Optional Infinitive". Journal of Speech, Language, and Hearing Research. 38 (4): 850–863. 1 August 1995. doi:10.1044/jshr.3804.850.
^ van der Lely, Heather K.J. (February 2005). "Domain-specific cognitive systems: insight from Grammatical-SLI". Trends in Cognitive Sciences. 9 (2): 53–59. doi:10.1016/j.tics.2004.12.002.
^ Gathercole, Susan E; Baddeley, Alan D (1 June 1990). "Phonological memory deficits in language disordered children: Is there a causal connection?". Journal of Memory and Language. 29 (3): 336–360. doi:10.1016/0749-596X(90)90004-J.
^ Ullman, Michael T.; Pierpont, Elizabeth I. (1 January 2005). "Specific Language Impairment is not Specific to Language: the Procedural Deficit Hypothesis". Cortex. 41 (3): 399–433. doi:10.1016/S0010-9452(08)70276-4.
^ Bishop, Dorothy V. M. (2006). "Developmental cognitive genetics: How psychology can inform genetics and vice versa". Quarterly Journal of Experimental Psychology (2006). 59 (7): 1153–1168. doi:10.1080/17470210500489372. PMC 2409179.
^ Clegg, J.; Hollis, C.; Mawhood, L.; Rutter, M. (February 2005). "Developmental language disorders - a follow-up in later adult life. Cognitive, language and psychosocial outcomes". Journal of Child Psychology and Psychiatry. 46 (2): 128–149. doi:10.1111/j.1469-7610.2004.00342.x.

External links

Helpful article by Professor Maggie Snowling: Dyslexia and developmental language disorder: same or different?
Raising Awareness of Language Learning Impairments (RALLI): Information about DLD via YouTube and Slideshare
Talking Point: Check the progress of your child's language development
What Works: Database of evidence-based interventions

[Bishop2017-1] Bishop, Dorothy V.M.; Snowling, Margaret J.; Thompson, Paul A.; Greenhalgh, Trisha (October 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. doi:10.1111/jcpp.12721.

[Bishop2014-2] Bishop, D. V. M. (July 2014). "Ten questions about terminology for children with unexplained language problems". International Journal of Language & Communication Disorders. 49 (4): 381–415. doi:10.1111/1460-6984.12101.

[3] Ingram, T. T. S.; Reid, J. F. (June 1956). "Developmental Aphasia Observed in a Department of Child Psychiatry". Archives of Disease in Childhood. 31 (157): 161–172. PMC 2011959.

[4] Rapin, Isabelle (September 1996). "Practitioner Review: Developmental Language Disorders: A Clinical Update". Journal of Child Psychology and Psychiatry. 37 (6): 643–655. doi:10.1111/j.1469-7610.1996.tb01456.x.

[5] Leonard, Laurence B. (April 1991). "Specific Language Impairment as a Clinical Category". Language, Speech, and Hearing Services in Schools. 22 (2): 66–68. doi:10.1044/0161-1461.2202.66.

[Bishop2016-6] Bishop, D. V. M.; Snowling, Margaret J.; Thompson, Paul A.; Greenhalgh, Trisha; Schiller, Niels O. (8 July 2016). "CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children". PLOS ONE. 11 (7): e0158753. doi:10.1371/journal.pone.0158753.{{cite journal}}: CS1 maint: unflagged free DOI (link)

[7] Bercow, J. (2008). The Bercow Report: A Review of Services for Children and Young People (0-19) with Speech, Language and Communication Needs Archived 2012-10-16 at the Wayback Machine. Nottingham: DCSF Publications. However, the UK special educational needs system uses SLCN in a manner which is more similar to DLD.

[8] van Weerdenburg, Marjolijn; Verhoeven, Ludo; van Balkom, Hans (February 2006). "Towards a typology of specific language impairment". Journal of Child Psychology and Psychiatry. 47 (2): 176–189. doi:10.1111/j.1469-7610.2005.01454.x.

[9] "Classification of Children With Specific Language Impairment". Journal of Speech, Language, and Hearing Research. 42 (5): 1195–1204. 1 October 1999. doi:10.1044/jslhr.4205.1195.

[10] Leonard, L. B. (2014). Children with specific language impairment, 2nd edition. Cambridge, MA: MIT Press.^{[page needed]}

[11] Bishop, D. V. M. (January 1982). "COMPREHENSION OF SPOKEN, WRITTEN AND SIGNED SENTENCES IN CHILDHOOD LANGUAGE DISORDERS". Journal of Child Psychology and Psychiatry. 23 (1): 1–20. doi:10.1111/j.1469-7610.1982.tb00045.x.

[12] Paul, Rhea (June 1990). "Comprehension strategies: Interactions between world knowledge and the development of sentence comprehension". Topics in Language Disorders. 10 (3): 63–75.

[13] Leonard, Laurence B.; Deevy, Patricia (2010). "Tense and Aspect in Sentence Interpretation by Children with Specific Language Impairment". Journal of child language. 37 (2): 395–418. doi:10.1017/S0305000909990018. PMC 3640588.

[14] Rice, M. L., & Bode, J. V. (1993)^{[full citation needed]}

[Kuiack_et_al_2019-15] Kuiack, Alyssa; Archibald, Lisa (9 July 2019). "Developmental Language Disorder: The Childhood Condition We Need to Start Talking About". Frontiers for Young Minds. 7. doi:10.3389/frym.2019.00094.{{cite journal}}: CS1 maint: unflagged free DOI (link)

[16] Rice, Mabel L.; Bode, John V. (25 July 2016). "GAPS in the verb lexicons of children with specific language impairment". First Language. 13 (37): 113–131. doi:10.1177/014272379301303707.

[17] German, Diane J. (November 1992). "Word-finding intervention for children and adolescents". Topics in Language Disorders. 13 (1): 33–50.

[18] Adams, Catherine (January 2001). "Clinical diagnostic and intervention studies of children with semantic—pragmatic language disorder". International Journal of Language & Communication Disorders. 36 (3): 289–305. doi:10.1080/lcd.36.3.289.305.

[19] Van der Lely, Heather K. J. (1 February 1997). "Narrative discourse in Grammatical specific language impaired children: a modular language deficit?". Journal of Child Language. 24 (1): 221–256. doi:10.1017/s0305000996002966. PMID 9154015.

[20] Gathercole, Susan E. (25 July 2016). "Word learning in language-impaired children". Child Language Teaching and Therapy. 9 (3): 187–199. doi:10.1177/026565909300900302.

[21] Montgomery, James W. (May 2002). "Information Processing and Language Comprehension in Children with Specific Language Impairment". Topics in Language Disorders. 22 (3): 62–84.

[22] Rvachew, S., & Brosseau-Lapre, F. (2012). Developmental Phonological Disorders: Foundations of clinical Practice: Plural Publishing Inc.^{[page needed]}

[23] Klein, Edward S.; Flint, Cari B. (July 2006). "Measurement of Intelligibility in Disordered Speech". Language, Speech, and Hearing Services in Schools. 37 (3): 191–199. doi:10.1044/0161-1461(2006/021).

[24] "Phonological and Spatial Processing Abilities in Language- and Reading-Impaired Children". Journal of Speech and Hearing Disorders. 53 (3): 316–327. 1 August 1988. doi:10.1044/jshd.5303.316.

[25] "Prevalence of Speech Delay in 6-Year-Old Children and Comorbidity With Language Impairment". Journal of Speech, Language, and Hearing Research. 42 (6): 1461–1481. 1 December 1999. doi:10.1044/jslhr.4206.1461.

[26] Waring, R.; Knight, R. (January 2013). "How should children with speech sound disorders be classified? A review and critical evaluation of current classification systems". International Journal of Language & Communication Disorders. 48 (1): 25–40. doi:10.1111/j.1460-6984.2012.00195.x.

[27] Bowen, C. (2015). Children's Speech Sound Disorders (2nd ed.). Oxford: Wiley-Blackwell.^{[page needed]}

[28] Broomfield, Jan; Dodd, Barbara (January 2004). "Children with speech and language disability: caseload characteristics". International Journal of Language & Communication Disorders. 39 (3): 303–324. doi:10.1080/13682820310001625589.

[29] Law, James; Garrett, Zoe; Nye, Chad (21 July 2003). "Speech and language therapy interventions for children with primary speech and language delay or disorder". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD004110.

[Bishop1987-30] "Language-Impaired 4-Year-Olds". Journal of Speech and Hearing Disorders. 52 (2): 156–173. 1 May 1987. doi:10.1044/jshd.5202.156.

[Bishop2006-31] Bishop, Dorothy V M (October 2006). "What Causes Specific Language Impairment in Children?". Current Directions in Psychological Science. 15 (5): 217–221. doi:10.1111/j.1467-8721.2006.00439.x. PMC 2582396.

[32] Bishop, D. V. M.; North, T.; Donlan, C. (12 November 2008). "GENETIC BASIS OF SPECIFIC LANGUAGE IMPAIRMENT: EVIDENCE FROM A TWIN STUDY". Developmental Medicine & Child Neurology. 37 (1): 56–71. doi:10.1111/j.1469-8749.1995.tb11932.x.

[33] Fisher, S. E., Vargha Khadem, F., Watkins, K. E., Monaco, A. P., & Pembrey, M. E. (1998). Localisation of a gene implicated in a severe speech and language disorder. Nature Genetics, 18, 168-170.

[34] Fisher, S (September 2006). "Tangled webs: Tracing the connections between genes and cognition". Cognition. 101 (2): 270–297. doi:10.1016/j.cognition.2006.04.004.

[35] Fisher, Simon E.; Scharff, Constance (April 2009). "FOXP2 as a molecular window into speech and language". Trends in Genetics. 25 (4): 166–177. doi:10.1016/j.tig.2009.03.002.

[36] Whitehouse, Andrew J O; Watt, Helen J; Line, E A; Bishop, Dorothy V M (2009). "Adult psychosocial outcomes of children with specific language impairment, pragmatic language impairment and autism". International Journal of Language & Communication Disorders. 44 (4): 511–528. doi:10.1080/13682820802708098. PMC 2835860.

[37] Fundudis, T., Kolvin, I., & Garside, R. (1979). Speech Retarded and Deaf Children: Their Psychological Development. London: Academic Press.^{[page needed]}

[38] Robinson, Roger J. (12 November 2008). "CAUSES AND ASSOCIATIONS OF SEVERE AND PERSISTENT SPECIFIC SPEECH AND LANGUAGE DISORDERS IN CHILDREN". Developmental Medicine & Child Neurology. 33 (11): 943–962. doi:10.1111/j.1469-8749.1991.tb14811.x.

[Norbury2016-39] Norbury, Courtenay Frazier; Gooch, Debbie; Wray, Charlotte; Baird, Gillian; Charman, Tony; Simonoff, Emily; Vamvakas, George; Pickles, Andrew (November 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. doi:10.1111/jcpp.12573.

[40] Hill, Elisabeth L. (January 2001). "Non-specific nature of specific language impairment: a review of the literature with regard to concomitant motor impairments". International Journal of Language & Communication Disorders. 36 (2): 149–171. doi:10.1080/13682820010019874. PMID 11344592.

[41] Sanjeevan, T; Rosenbaum, D.A.; Miller, C; Hell, J.G.V; Weiss, D.J; Mainela-Arnold, E. "Motor Issues in Specific Language Impairment: a Window into the Underlying Impairment. Current Developmental Disorders". 2(3), 228–236. doi:10.1007/s40474-015-0051-9.

[42] Krishnan, Saloni; Watkins, Kate E.; Bishop, Dorothy V.M. (September 2016). "Neurobiological Basis of Language Learning Difficulties". Trends in Cognitive Sciences. 20 (9): 701–714. doi:10.1016/j.tics.2016.06.012.

[43] Herbert, Martha R.; Kenet, Tal (June 2007). "Brain Abnormalities in Language Disorders and in Autism". Pediatric Clinics of North America. 54 (3): 563–583. doi:10.1016/j.pcl.2007.02.007. PMID 17543910.

[44] Tomblin, J. Bruce; Records, Nancy L.; Zhang, Xuyang (December 1996). "A System for the Diagnosis of Specific Language Impairment in Kindergarten Children". Journal of Speech, Language, and Hearing Research. 39 (6): 1284–1294. doi:10.1044/jshr.3906.1284.

[45] Bishop, Dorothy V. M. (November 2017). "Why is it so hard to reach agreement on terminology? The case of developmental language disorder (DLD)". International Journal of Language & Communication Disorders. 52 (6): 671–680. doi:10.1111/1460-6984.12335. PMID 28714100.

[46] Identifying Red Flags for Developmental Language Disorder. (n.d.). Retrieved from https://www.boystownhospital.org/knowledge-center/red-flags-developmental-language-disorder.

[47] Paul, R. (2006). Language Disorders from Infancy through Adolescence: Assessment and Intervention, 3rd Edition. St. Louis: Mosby-Year Book.^{[page needed]}

[48] Roth, F. P., & Worthington, C. K. (2010). Treatment resource manual for speech-language pathology, 4th edition. San Diego: Singular Publishing.^{[page needed]}

[49] Ebbels, Susan (25 July 2016). "Teaching grammar to school-aged children with specific language impairment using Shape Coding". Child Language Teaching and Therapy. 23 (1): 67–93. doi:10.1191/0265659007072143.

[50] Bryan, A., Colourful Semantics., in Language disorders in children and adults: psycholinguistic approaches to therapy., S. Chiat, J. Law, and J. Marshall, Editors. 1997, Whurr: London^{[page needed]}

[51] Gallagher, Tanya M. (1996). "Social-interactional approaches to child language intervention". In Beitchman, Joseph H.; Cohen, Nancy J.; Konstantareas, M. Mary; Tannock, Rosemary (eds.). Language, Learning, and Behavior Disorders: Developmental, Biological, and Clinical Perspectives. Cambridge University Press. pp. 418–435. ISBN 978-0-521-47229-6. {{cite book}}: External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)

[52] "The Effectiveness of Parent-Implemented Language Interventions: A Meta-Analysis". American Journal of Speech-Language Pathology. 20 (3): 180–199. 1 August 2011. doi:10.1044/1058-0360(2011/10-0055).

[53] Tosh, Rachel; Arnott, Wendy; Scarinci, Nerina (May 2017). "Parent-implemented home therapy programmes for speech and language: a systematic review". International Journal of Language & Communication Disorders. 52 (3): 253–269. doi:10.1111/1460-6984.12280.

[54] Archibald, Lisa MD (January 2017). "SLP-educator classroom collaboration: A review to inform reason-based practice". Autism & Developmental Language Impairments. 2. doi:10.1177/2396941516680369.

[55] McCartney, Elspeth; Boyle, James; Ellis, Sue; Bannatyne, Susan; Turnbull, Mary (26 March 2010). "Indirect language therapy for children with persistent language impairment in mainstream primary schools: outcomes from a cohort intervention". International Journal of Language & Communication Disorders. doi:10.3109/13682820903560302.

[56] McCartney, Elspeth; Boyle, James; Ellis, Sue; Bannatyne, Susan; Turnbull, Mary (26 March 2010). "Indirect language therapy for children with persistent language impairment in mainstream primary schools: outcomes from a cohort intervention". International Journal of Language & Communication Disorders. doi:10.3109/13682820903560302.

[57] Law, James; Garrett, Zoe; Nye, Chad (August 2004). "The Efficacy of Treatment for Children With Developmental Speech and Language Delay/Disorder". Journal of Speech, Language, and Hearing Research. 47 (4): 924–943. doi:10.1044/1092-4388(2004/069). PMID 15324296.

[58] Boyle, James; McCartney, Elspeth; O'Hare, Anne; Law, James (November 2010). "Intervention for mixed receptive-expressive language impairment: a review". Developmental Medicine & Child Neurology. 52 (11): 994–999. doi:10.1111/j.1469-8749.2010.03750.x.

[59] Ebbels, Susan (9 December 2013). "Effectiveness of intervention for grammar in school-aged children with primary language impairments: A review of the evidence". Child Language Teaching and Therapy. 30 (1): 7–40. doi:10.1177/0265659013512321.

[60] Ebbels, Susan H.; Marić, Nataša; Murphy, Aoife; Turner, Gail (January 2014). "Improving comprehension in adolescents with severe receptive language impairments: a randomized control trial of intervention for coordinating conjunctions". International Journal of Language & Communication Disorders. 49 (1): 30–48. doi:10.1111/1460-6984.12047.

[61] Ebbels, Susan H.; Wright, Lisa; Brockbank, Sally; Godfrey, Caroline; Harris, Catherine; Leniston, Hannah; Neary, Kate; Nicoll, Hilary; Nicoll, Lucy; Scott, Jackie; Marić, Nataša (July 2017). "Effectiveness of 1:1 speech and language therapy for older children with (developmental) language disorder". International Journal of Language & Communication Disorders. 52 (4): 528–539. doi:10.1111/1460-6984.12297.

[62] Johnson, Carla J.; Beitchman, Joseph H.; Brownlie, E. B. (February 2010). "Twenty-Year Follow-Up of Children With and Without Speech-Language Impairments: Family, Educational, Occupational, and Quality of Life Outcomes". American Journal of Speech-Language Pathology. 19 (1): 51–65. doi:10.1044/1058-0360(2009/08-0083).

[63] "A Longitudinal Investigation of Reading Outcomes in Children With Language Impairments". Journal of Speech, Language, and Hearing Research. 45 (6): 1142–1157. 1 December 2002. doi:10.1044/1092-4388(2002/093).

[64] Snowling, Margaret J.; Adams, John W.; Bishop, D. V. M.; Stothard, Susan E. (2001). "Educational attainments of school leavers with a preschool history of speech-language impairments". International Journal of Language & Communication Disorders. 36 (2): 173–183. doi:10.1080/13682820120976.

[65] Simkin, Zoë; Conti-Ramsden, Gina (26 July 2016). "Evidence of reading difficulty in subgroups of children with specific language impairment". Child Language Teaching and Therapy. 22 (3): 315–331. doi:10.1191/0265659006ct310xx.

[66] Botting, Nicola (March 2005). "Non-verbal cognitive development and language impairment". Journal of Child Psychology and Psychiatry. 46 (3): 317–326. doi:10.1111/j.1469-7610.2004.00355.x.

[67] Cohen, Nancy (2001). Language impairment and psychopathology in infants, children, and adolescents. Thousand Oaks: Sage Publications. ISBN 0-7619-2025-0. OCLC 45749780.

[68] "Social Difficulties and Victimization in Children With SLI at 11 Years of Age". Journal of Speech, Language, and Hearing Research. 47 (1): 145–161. 1 February 2004. doi:10.1044/1092-4388(2004/013).

[69] Clegg, J.; Hollis, C.; Mawhood, L.; Rutter, M. (February 2005). "Developmental language disorders - a follow-up in later adult life. Cognitive, language and psychosocial outcomes". Journal of Child Psychology and Psychiatry. 46 (2): 128–149. doi:10.1111/j.1469-7610.2004.00342.x.

[70] Snowling, Margaret J.; Bishop, D.V.M.; Stothard, Susan E.; Chipchase, Barry; Kaplan, Carole (9 June 2006). "Psychosocial outcomes at 15 years of children with a preschool history of speech-language impairment". Journal of Child Psychology and Psychiatry. 47 (8): 759–765. doi:10.1111/j.1469-7610.2006.01631.x.

[71] "Prevalence of Specific Language Impairment in Kindergarten Children". Journal of Speech, Language, and Hearing Research. 40 (6): 1245–1260. 1 December 1997. doi:10.1044/jslhr.4006.1245.

[72] Tomblin, J. Bruce; Records, Nancy L.; Buckwalter, Paula; Zhang, Xuyang; Smith, Elaine; O’Brien, Marlea (December 1997). "Prevalence of Specific Language Impairment in Kindergarten Children". Journal of speech, language, and hearing research. 40 (6): 1245–1260. PMC 5075245.

[73] Bishop, D. V. M. (1997). Uncommon Understanding: Development and Disorders of Language Comprehension in Children. Hove: Psychology Press.

[74] "Specific Language Impairment as a Period of Extended Optional Infinitive". Journal of Speech, Language, and Hearing Research. 38 (4): 850–863. 1 August 1995. doi:10.1044/jshr.3804.850.

[75] van der Lely, Heather K.J. (February 2005). "Domain-specific cognitive systems: insight from Grammatical-SLI". Trends in Cognitive Sciences. 9 (2): 53–59. doi:10.1016/j.tics.2004.12.002.

[76] Gathercole, Susan E; Baddeley, Alan D (1 June 1990). "Phonological memory deficits in language disordered children: Is there a causal connection?". Journal of Memory and Language. 29 (3): 336–360. doi:10.1016/0749-596X(90)90004-J.

[77] Ullman, Michael T.; Pierpont, Elizabeth I. (1 January 2005). "Specific Language Impairment is not Specific to Language: the Procedural Deficit Hypothesis". Cortex. 41 (3): 399–433. doi:10.1016/S0010-9452(08)70276-4.

[78] Bishop, Dorothy V. M. (2006). "Developmental cognitive genetics: How psychology can inform genetics and vice versa". Quarterly Journal of Experimental Psychology (2006). 59 (7): 1153–1168. doi:10.1080/17470210500489372. PMC 2409179.

[79] Clegg, J.; Hollis, C.; Mawhood, L.; Rutter, M. (February 2005). "Developmental language disorders - a follow-up in later adult life. Cognitive, language and psychosocial outcomes". Journal of Child Psychology and Psychiatry. 46 (2): 128–149. doi:10.1111/j.1469-7610.2004.00342.x.

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 ==Classification==
 ===Terminology===
-The term developmental language disorder (DLD) was endorsed in a consensus study involving a panel of experts (CATALISE Consortium) in 2017.<ref name=Bishop2017>Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & The CATALISE Consortium. (2017). [http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12721/abstract Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology]. Journal of Child Psychology & Psychiatry. doi:10.1371/journal.pone.0158753
+The term developmental language disorder (DLD) was endorsed in a consensus study involving a panel of experts (CATALISE Consortium) in 2017.<ref name=Bishop2017>{{cite journal |last1=Bishop |first1=Dorothy V.M. |last2=Snowling |first2=Margaret J. |last3=Thompson |first3=Paul A. |last4=Greenhalgh |first4=Trisha |title=Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology |journal=Journal of Child Psychology and Psychiatry |date=October 2017 |volume=58 |issue=10 |pages=1068–1080 |doi=10.1111/jcpp.12721 }}</ref> The study was conducted in response to concerns that a wide range of terminology was used in this area, with the consequence that there was poor communication, lack of public recognition, and in some cases children were denied access to services. Developmental language disorder is a subset of language disorder, which is itself a subset of the broader category of speech, language and communication needs (SLCN).
-</ref> The study was conducted in response to concerns that a wide range of terminology was used in this area, with the consequence that there was poor communication, lack of public recognition, and in some cases children were denied access to services. Developmental language disorder is a subset of language disorder, which is itself a subset of the broader category of speech, language and communication needs (SLCN).
-The terminology for children’s language disorders has been extremely wide-ranging and confusing, with many labels that have overlapping but not necessarily identical meanings.<ref name=Bishop2014>Bishop, D. V. M. (2014). [http://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12101/abstract Ten questions about terminology for children with unexplained language problems]. International Journal of Language & Communication Disorders, 49(4), 381-415. doi:10.1111/1460-6984.12101
+The terminology for children’s language disorders has been extremely wide-ranging and confusing, with many labels that have overlapping but not necessarily identical meanings.<ref name=Bishop2014>{{cite journal |last1=Bishop |first1=D. V. M. |title=Ten questions about terminology for children with unexplained language problems |journal=International Journal of Language & Communication Disorders |date=July 2014 |volume=49 |issue=4 |pages=381–415 |doi=10.1111/1460-6984.12101 }}</ref> In part this confusion reflected uncertainty about the boundaries of DLD, and the existence of different subtypes. Historically, the terms ‘’developmental dysphasia’’ or ‘’developmental aphasia’’ were used to describe children with the clinical picture of DLD.<ref>{{cite journal |last1=Ingram |first1=T. T. S. |last2=Reid |first2=J. F. |title=Developmental Aphasia Observed in a Department of Child Psychiatry |journal=Archives of Disease in Childhood |date=June 1956 |volume=31 |issue=157 |pages=161–172 |pmc=2011959 }}</ref> These terms have, however, largely been abandoned, as they suggest parallels with adult acquired [[aphasia]]. This is misleading, as DLD is not caused by brain damage.<ref>{{cite journal |last1=Rapin |first1=Isabelle |title=Practitioner Review: Developmental Language Disorders: A Clinical Update |journal=Journal of Child Psychology and Psychiatry |date=September 1996 |volume=37 |issue=6 |pages=643–655 |doi=10.1111/j.1469-7610.1996.tb01456.x }}</ref>
-</ref> In part this confusion reflected uncertainty about the boundaries of DLD, and the existence of different subtypes. Historically, the terms ‘’developmental dysphasia’’ or ‘’developmental aphasia’’ were used to describe children with the clinical picture of DLD.<ref>Ingram, T. T. S., & Reid, J. F. (1956). [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2011959/ Developmental aphasia observed in a department of child psychiatry]. Archives of Disease in Childhood, 31, 161-172.
-</ref> These terms have, however, largely been abandoned, as they suggest parallels with adult acquired [[aphasia]]. This is misleading, as DLD is not caused by brain damage.<ref>Rapin, I. (1996). [http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.1996.tb01456.x/abstract Developmental language disorders: a clinical update]. Journal of Child Psychology and Psychiatry, 37, 643-655. doi:10.1111/j.1469-7610.1996.tb01456.x
-</ref>
-Although the term DLD has been used for many years, it has been less common than the term [[specific language impairment]] (SLI),<ref name=Bishop2014 /> which has been widely adopted, especially in North America.<ref>Leonard, L. B. (1991). [http://lshss.pubs.asha.org/article.aspx?articleid=1777973 Specific language impairment as a clinical category]. Language, Speech, and Hearing Services in Schools, 22, 66-68. doi:10.1044/0161-1461.2202.66</ref> The definition of SLI overlaps with DLD, but was rejected by the CATALISE panel because it was seen as overly restrictive in implying that the child had relatively pure problems with language in the absence of any other impairments. Children with such selective problems are relatively rare, and there is no evidence that they respond differently to intervention, or have different causal factors, from other children with language problems.<ref name=Bishop2016>Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & The CATALISE Consortium. (2016). [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0158753 CATALISE: a multinational and multidisciplinary Delphi consensus study]. Identifying language impairments in children. PLOS One, 11(7), e0158753. doi:10.1371/journal.pone.0158753
+Although the term DLD has been used for many years, it has been less common than the term [[specific language impairment]] (SLI),<ref name=Bishop2014 /> which has been widely adopted, especially in North America.<ref>{{cite journal |last1=Leonard |first1=Laurence B. |title=Specific Language Impairment as a Clinical Category |journal=Language, Speech, and Hearing Services in Schools |date=April 1991 |volume=22 |issue=2 |pages=66–68 |doi=10.1044/0161-1461.2202.66 }}</ref> The definition of SLI overlaps with DLD, but was rejected by the CATALISE panel because it was seen as overly restrictive in implying that the child had relatively pure problems with language in the absence of any other impairments. Children with such selective problems are relatively rare, and there is no evidence that they respond differently to intervention, or have different causal factors, from other children with language problems.<ref name=Bishop2016>{{cite journal |last1=Bishop |first1=D. V. M. |last2=Snowling |first2=Margaret J. |last3=Thompson |first3=Paul A. |last4=Greenhalgh |first4=Trisha |last5=Schiller |first5=Niels O. |title=CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children |journal=PLOS ONE |date=8 July 2016 |volume=11 |issue=7 |pages=e0158753 |doi=10.1371/journal.pone.0158753 }}</ref>
-</ref>
 In the UK education system the term s''peech, language and communication needs (SLCN)'' is widely used, but this is far broader than DLD, and includes children with speech, language and social communication difficulties arising from a wide range of causes.<ref>Bercow, J. (2008). [http://www.dcsf.gov.uk/bercowreview The Bercow Report: A Review of Services for Children and Young People (0-19) with Speech, Language and Communication Needs] {{Webarchive|url=https://web.archive.org/web/20121016030921/http://www.dcsf.gov.uk/bercowreview/ |date=2012-10-16 }}. Nottingham: DCSF Publications. However, the UK special educational needs system uses SLCN in a manner which is more similar to DLD.</ref>
@@ Line 31: / Line 26: @@
 ===Types of language difficulty===
-DLD can affect a range of areas of language and the degree of impairment in different areas of language can vary from child to child.<ref>van Weerdenburg, M., Verhoeven, L., & van Balkom, H. (2006). [http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2005.01454.x/abstract Towards a typology of specific language impairment]. Journal of Child Psychology and Psychiatry, 47(2), 176-189.
+DLD can affect a range of areas of language and the degree of impairment in different areas of language can vary from child to child.<ref>{{cite journal |last1=van Weerdenburg |first1=Marjolijn |last2=Verhoeven |first2=Ludo |last3=van Balkom |first3=Hans |title=Towards a typology of specific language impairment |journal=Journal of Child Psychology and Psychiatry |date=February 2006 |volume=47 |issue=2 |pages=176–189 |doi=10.1111/j.1469-7610.2005.01454.x }}</ref> However, although there have been attempts to define different subtypes, these have not generally resulted in robust categories.<ref>{{cite journal |title=Classification of Children With Specific Language Impairment |journal=Journal of Speech, Language, and Hearing Research |date=1 October 1999 |volume=42 |issue=5 |pages=1195–1204 |doi=10.1044/jslhr.4205.1195 }}</ref> The recommendation of the CATALISE panel was that the specific areas of impairment should be assessed and documented for individual children, while recognizing that different children might have different combinations of problems. The areas which can be affected are:
+* [[Grammar]] – This involves the ability to combine words into grammatically correct sentences (syntax) and to combine parts of words together (morphology) such as adding grammatical endings to verbs like -ing or -ed or to add prefixes and suffixes like dis- or -ation. For instance, a child may say 'me jump here', instead of 'I jumped here'.<ref>Leonard, L. B. (2014). Children with specific language impairment, 2nd edition. Cambridge, MA: MIT Press.{{pn}}</ref> Comprehension of sentences can also be affected. For instance, there may be difficulty understanding meaning expressed by word order, and so confusion about what is blue in a sentence like 'the pencil on the shoe is blue',<ref>{{cite journal |last1=Bishop |first1=D. V. M. |title=COMPREHENSION OF SPOKEN, WRITTEN AND SIGNED SENTENCES IN CHILDHOOD LANGUAGE DISORDERS |journal=Journal of Child Psychology and Psychiatry |date=January 1982 |volume=23 |issue=1 |pages=1–20 |doi=10.1111/j.1469-7610.1982.tb00045.x }}</ref> and a tendency to use general knowledge rather than linguistic cues to meaning,<ref>{{cite journal |last1=Paul |first1=Rhea |title=Comprehension strategies: Interactions between world knowledge and the development of sentence comprehension |journal=Topics in Language Disorders |date=June 1990 |volume=10 |issue=3 |pages=63–75 |url=http://journals.lww.com/topicsinlanguagedisorders/citation/1990/06000/comprehension_strategies__interactions_between.7.aspx }}</ref> or problems in interpreting grammatical markers of number or tense.<ref>{{cite journal |last1=Leonard |first1=Laurence B. |last2=Deevy |first2=Patricia |title=Tense and Aspect in Sentence Interpretation by Children with Specific Language Impairment |journal=Journal of child language |date=2010 |volume=37 |issue=2 |pages=395–418 |doi=10.1017/S0305000909990018 |pmc=3640588 }}</ref>
-</ref> However, although there have been attempts to define different subtypes, these have not generally resulted in robust categories.<ref>Conti-Ramsden, G., & Botting, N. (1999). [http://jslhr.pubs.asha.org/article.aspx?articleid=1781170 Classification of children with specific language impairment: Longitudinal considerations]. Journal of Speech, Language, and Hearing Research, 42(5), 1195-1204.
+* [[Semantics]] – This refers to children’s ability to understand the meaning of words and how meanings are expressed by combining words together. Children with DLD often have limited vocabulary and may make heavy use of a small set of words with rather general meanings.<ref>Rice, M. L., & Bode, J. V. (1993){{full}}</ref> As children with developmental language disorder get older, they may have a hard time understanding that some words have multiple meanings, for example the word “cold,” which can mean a low temperature, a sickness, or being unfriendly.<ref name="Kuiack et al 2019">{{cite journal |last1=Kuiack |first1=Alyssa |last2=Archibald |first2=Lisa |title=Developmental Language Disorder: The Childhood Condition We Need to Start Talking About |journal=Frontiers for Young Minds |date=9 July 2019 |volume=7 |doi=10.3389/frym.2019.00094 }}</ref><ref>{{cite journal |last1=Rice |first1=Mabel L. |last2=Bode |first2=John V. |title=GAPS in the verb lexicons of children with specific language impairment |journal=First Language |date=25 July 2016 |volume=13 |issue=37 |pages=113–131 |doi=10.1177/014272379301303707 }}</ref>
-</ref> The recommendation of the CATALISE panel was that the specific areas of impairment should be assessed and documented for individual children, while recognizing that different children might have different combinations of problems. The areas which can be affected are:
+* Word finding – Children with word finding difficulties may know a word, but have difficulty accessing it for production<ref>{{cite journal |last1=German |first1=Diane J. |title=Word-finding intervention for children and adolescents |journal=Topics in Language Disorders |date=November 1992 |volume=13 |issue=1 |pages=33–50 |url=http://journals.lww.com/topicsinlanguagedisorders/citation/1992/11000/word_finding_intervention_for_children_and.6.aspx }}</ref> – similar to the [[tip of the tongue]] phenomenon.
-* [[Grammar]] – This involves the ability to combine words into grammatically correct sentences (syntax) and to combine parts of words together (morphology) such as adding grammatical endings to verbs like -ing or -ed or to add prefixes and suffixes like dis- or -ation. For instance, a child may say 'me jump here', instead of 'I jumped here'.<ref>Leonard, L. B. (2014). Children with specific language impairment, 2nd edition. Cambridge, MA: MIT Press.
+* [[Pragmatics]] – Pragmatics refers to the ability to select the appropriate message, or interpret what others say, in relation to context. Pragmatic difficulties can give an impression of oddity, with the content of language not fitting the environmental or social context; comprehension may be over-literal; the child may chatter incessantly, be poor at turn-taking in conversation and maintaining a topic<ref>{{cite journal |last1=Adams |first1=Catherine |title=Clinical diagnostic and intervention studies of children with semantic—pragmatic language disorder |journal=International Journal of Language & Communication Disorders |date=January 2001 |volume=36 |issue=3 |pages=289–305 |doi=10.1080/lcd.36.3.289.305 }}</ref>
-</ref> Comprehension of sentences can also be affected. For instance, there may be difficulty understanding meaning expressed by word order, and so confusion about what is blue in a sentence like 'the pencil on the shoe is blue',<ref>Bishop, D. V. M. (1982). [http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.1982.tb00045.x/abstract Comprehension of spoken, written and signed sentences in childhood language disorders]. Journal of Child Psychology and Psychiatry, 23, 1-20.
+* [[Discourse]] – Discourse refers to a level of organization of language beyond the sentence. Child with limitations in this domain may have limited ability to tell a story or describe a set of events in a logical sequence<ref>{{cite journal |last1=Van der Lely |first1=Heather K. J. |title=Narrative discourse in Grammatical specific language impaired children: a modular language deficit? |journal=Journal of Child Language |date=1 February 1997 |volume=24 |issue=1 |pages=221–256 |doi=10.1017/s0305000996002966 |pmid=9154015 }}</ref>
-</ref> and a tendency to use general knowledge rather than linguistic cues to meaning,<ref>Paul, R. (1990). [http://journals.lww.com/topicsinlanguagedisorders/citation/1990/06000/comprehension_strategies__interactions_between.7.aspx Comprehension strategies: interactions between world knowledge and the development of sentence comprehension]. Topics in Language Disorders, 10(3), 63-75.
+* [[Verbal memory]] and learning – Problems with remembering words or sentences can affect both the learning of new vocabulary,<ref>{{cite journal |last1=Gathercole |first1=Susan E. |title=Word learning in language-impaired children |journal=Child Language Teaching and Therapy |date=25 July 2016 |volume=9 |issue=3 |pages=187–199 |doi=10.1177/026565909300900302 }}</ref> and the understanding of long or complex sentences.<ref>{{cite journal |last1=Montgomery |first1=James W. |title=Information Processing and Language Comprehension in Children with Specific Language Impairment |journal=Topics in Language Disorders |date=May 2002 |volume=22 |issue=3 |pages=62–84 |url=http://journals.lww.com/topicsinlanguagedisorders/Abstract/2002/05000/Information_Processing_and_Language_Comprehension.7.aspx }}</ref> Young children with DLD may say their first words later than other children. It may also take children with DLD longer to learn and remember novel words.<ref name="Kuiack et al 2019"/>
-</ref> or problems in interpreting grammatical markers of number or tense.<ref>Leonard, L. B., & Deevy, P. (2010). [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640588/|Tense and aspect in sentence interpretation by children with specific language impairment]. Journal of Child Language, 37(2), 395-418.
-</ref>
-* [[Semantics]] – This refers to children’s ability to understand the meaning of words and how meanings are expressed by combining words together. Children with DLD often have limited vocabulary and may make heavy use of a small set of words with rather general meanings.<ref>Rice, M. L., & Bode, J. V. (1993)</ref>. As children with developmental language disorder get older, they may have a hard time understanding that some words have multiple meanings, for example the word “cold,” which can mean a low temperature, a sickness, or being unfriendly.<ref>{{cite web |last1=Kennedy |first1=Michelle |title=Developmental Language Disorder: The Childhood Condition We Need to Start Talking About. |url=https://kids.frontiersin.org/article |website=Frontiers}}</ref> <ref>[http://journals.sagepub.com/doi/abs/10.1177/014272379301303707 GAPS in the verb lexicons of children with specific language impairment]. First Language, 13(37), 113-131. doi:10.1177/014272379301303707</ref>
-* Word finding – Children with word finding difficulties may know a word, but have difficulty accessing it for production<ref>German, D. J. (1992 ). [http://journals.lww.com/topicsinlanguagedisorders/citation/1992/11000/word_finding_intervention_for_children_and.6.aspx Word finding intervention for children and adolescents]. Topics in Language Disorders, 13, 33-50.
-</ref> – similar to the [[tip of the tongue]] phenomenon.
-* [[Pragmatics]] – Pragmatics refers to the ability to select the appropriate message, or interpret what others say, in relation to context. Pragmatic difficulties can give an impression of oddity, with the content of language not fitting the environmental or social context; comprehension may be over-literal; the child may chatter incessantly, be poor at turn-taking in conversation and maintaining a topic <ref>Adams, C. (2001). [http://onlinelibrary.wiley.com/doi/10.1080/lcd.36.3.289.305/abstract Clinical diagnostic and intervention studies of children with semantic-pragmatic language disorder]. International Journal of Language and Communication Disorders, 36, 289-305.
-</ref>
-* [[Discourse]] – Discourse refers to a level of organization of language beyond the sentence. Child with limitations in this domain may have limited ability to tell a story or describe a set of events in a logical sequence <ref>Van der Lely, H. K. J. (1997). [https://www.ncbi.nlm.nih.gov/pubmed/9154015 Narrative discourse in Grammatical specific language impairment: a modular language deficit?] Journal of Child Language, 24, 221-256.
-</ref>
-* [[Verbal memory]] and learning – Problems with remembering words or sentences can affect both the learning of new vocabulary,<ref>Gathercole, S. (1993). [http://journals.sagepub.com/doi/abs/10.1177/026565909300900302 Word learning in language impaired children]. Child Language Teaching and Therapy, 9, 187-199. doi:10.1177/026565909300900302
-</ref> and the understanding of long or complex sentences.<ref>Montgomery, J. (2002). [http://journals.lww.com/topicsinlanguagedisorders/Abstract/2002/05000/Information_Processing_and_Language_Comprehension.7.aspx Information processing and language comprehension in children with specific language impairment]. Topics in Language Disorders, 22, 62-84.
-</ref> Young children with DLD may say their first words later than other children. It may also take children with DLD longer to learn and remember novel words. <ref> Michelle Kennedy et al.. Developmental Language Disorder: The Childhood Condition We Need to Start Talking About. Retrieved from https://kids.frontiersin.org/article </ref>
-* [[Phonology]] – Phonology is the branch of linguistics concerned with the way sounds are combined together in words. Children with difficulties with phonology may fail to distinguish between certain speech sounds, such as 't' and 'k', so that 'cake' is produced as 'tate'. Such difficulties are not unusual as part of typical development in toddlers, but they would usually resolve by the time children are 4–5 years old.<ref>Rvachew, S., & Brosseau-Lapre, F. (2012). Developmental Phonological Disorders: Foundations of clinical Practice: Plural Publishing Inc.
+* [[Phonology]] – Phonology is the branch of linguistics concerned with the way sounds are combined together in words. Children with difficulties with phonology may fail to distinguish between certain speech sounds, such as 't' and 'k', so that 'cake' is produced as 'tate'. Such difficulties are not unusual as part of typical development in toddlers, but they would usually resolve by the time children are 4–5 years old.<ref>Rvachew, S., & Brosseau-Lapre, F. (2012). Developmental Phonological Disorders: Foundations of clinical Practice: Plural Publishing Inc.{{pn}}</ref> Difficulties with producing some speech sounds accurately may reduce intelligibility of speech.<ref>{{cite journal |last1=Klein |first1=Edward S. |last2=Flint |first2=Cari B. |title=Measurement of Intelligibility in Disordered Speech |journal=Language, Speech, and Hearing Services in Schools |date=July 2006 |volume=37 |issue=3 |pages=191–199 |doi=10.1044/0161-1461(2006/021) }}</ref> In addition, more subtle difficulties in recognising specific sounds in words ([[phonological awareness]]) can lead to literacy difficulties.<ref>{{cite journal |title=Phonological and Spatial Processing Abilities in Language- and Reading-Impaired Children |journal=Journal of Speech and Hearing Disorders |date=1 August 1988 |volume=53 |issue=3 |pages=316–327 |doi=10.1044/jshd.5303.316 }}</ref>
-</ref> Difficulties with producing some speech sounds accurately may reduce intelligibility of speech.<ref>Klein, E. S., & Flint, C. B. (2006). [http://lshss.pubs.asha.org/article.aspx?articleid=1762909 Measurement of intelligibility in disordered speech]. Language Speech and Hearing Services in Schools, 37(3), 191-199. doi:10.1044/0161-1461(2006/021)
-</ref> In addition, more subtle difficulties in recognising specific sounds in words ([[phonological awareness]]) can lead to literacy difficulties.<ref>Kamhi, A. G., Catts, H. W., Mauer, D., Apel, K., & Gentry, B. F. (1988). [https://jshd.pubs.asha.org/article.aspx?articleid=1775118 Phonological and spatial processing abilities in language- and reading-impaired children]. Journal of Speech and Hearing Disorders, 53, 316-327.
-</ref>
 ===Relationship with speech disorders===
 Speech is the act of articulating sounds, and this can be impaired for all kinds of reasons – a structural problem such as [[cleft lip and cleft palate]], a neurological problem affecting motor control of the speech apparatus [[dysarthria]], or inability to perceive distinctions between sounds because of [[hearing loss]]. Some distortions of speech sounds, such as a [[lisp]], are commonly seen in young children. These misarticulations should not be confused with language problems, which involve the ability to select and combine linguistic elements to express meanings, and the ability to comprehend meanings.
-Although speech disorders can be distinguished from language disorders, they can also co-occur.<ref>Shriberg, L. D., Tomblin, J. B., & McSweeny, J. L. (1999). [http://jslhr.pubs.asha.org/article.aspx?articleid=1781216 Prevalence of speech delay in 6-year-old children and comorbidity with language impairment]. Journal of Speech, Language and Hearing Research, 42(6), 1461-1481.
-</ref> When a child fails to produce distinctions between speech sounds for no obvious reason, this is typically regarded as a language problem affecting the learning of phonological contrasts. The classification of and terminology for disorders of speech sound production is a subject of considerable debate.<ref>Waring, R., & Knight, R. (2013). [http://onlinelibrary.wiley.com/doi/10.1111/j.1460-6984.2012.00195.x/abstract How should children with speech sound disorders be classified? A review and critical evaluation of current classification systems]. International Journal of Language & Communication Disorders, 48(1), 25-40. doi:10.1111/j.1460-6984.2012.00195.x
+Although speech disorders can be distinguished from language disorders, they can also co-occur.<ref>{{cite journal |title=Prevalence of Speech Delay in 6-Year-Old Children and Comorbidity With Language Impairment |journal=Journal of Speech, Language, and Hearing Research |date=1 December 1999 |volume=42 |issue=6 |pages=1461–1481 |doi=10.1044/jslhr.4206.1461 }}</ref> When a child fails to produce distinctions between speech sounds for no obvious reason, this is typically regarded as a language problem affecting the learning of phonological contrasts. The classification of and terminology for disorders of speech sound production is a subject of considerable debate.<ref>{{cite journal |last1=Waring |first1=R. |last2=Knight |first2=R. |title=How should children with speech sound disorders be classified? A review and critical evaluation of current classification systems |journal=International Journal of Language & Communication Disorders |date=January 2013 |volume=48 |issue=1 |pages=25–40 |doi=10.1111/j.1460-6984.2012.00195.x }}</ref> In practice, even for those with specialist skills, it is not always easy to distinguish between phonological disorders and other types of speech production problem.
+[[Speech sound disorder]] (SSD) is any problem with speech production arising from any cause.<ref>Bowen, C. (2015). Children's Speech Sound Disorders (2nd ed.). Oxford: Wiley-Blackwell.{{pn}}</ref>
-</ref> In practice, even for those with specialist skills, it is not always easy to distinguish between phonological disorders and other types of speech production problem.
-[[Speech sound disorder]] (SSD) is any problem with speech production arising from any cause.<ref>Bowen, C. (2015). Children's Speech Sound Disorders (2nd ed.). Oxford: Wiley-Blackwell.
+Speech sound disorders of unknown cause that are not accompanied by other language problems are a relatively common reason for young children to be referred to speech-language therapy (speech-language pathology).<ref>{{cite journal |last1=Broomfield |first1=Jan |last2=Dodd |first2=Barbara |title=Children with speech and language disability: caseload characteristics |journal=International Journal of Language & Communication Disorders |date=January 2004 |volume=39 |issue=3 |pages=303–324 |doi=10.1080/13682820310001625589 }}</ref> These often resolve by around 4–5 years of age with specialist intervention,<ref>{{cite journal |last1=Law |first1=James |last2=Garrett |first2=Zoe |last3=Nye |first3=Chad |title=Speech and language therapy interventions for children with primary speech and language delay or disorder |journal=Cochrane Database of Systematic Reviews |date=21 July 2003 |doi=10.1002/14651858.CD004110 }}</ref> and so would not meet criteria for DLD. Where such problems continue beyond five years of age, they are usually accompanied by problems in broader language domains and have a poorer prognosis,<ref name=Bishop1987>{{cite journal |title=Language-Impaired 4-Year-Olds |journal=Journal of Speech and Hearing Disorders |date=1 May 1987 |volume=52 |issue=2 |pages=156–173 |doi=10.1044/jshd.5202.156 }}</ref> so a diagnosis of DLD with SSD is then appropriate.
-</ref>
-Speech sound disorders of unknown cause that are not accompanied by other language problems are a relatively common reason for young children to be referred to speech-language therapy (speech-language pathology).<ref>Broomfield, J., & Dodd, B. (2004). [http://onlinelibrary.wiley.com/doi/10.1080/13682820310001625589/abstract Children with speech and language disability: caseload characteristics]. International Journal of Language and Communication Disorders, 39, 303-324.
-</ref> These often resolve by around 4–5 years of age with specialist intervention,<ref>Law, J., Garrett, Z., & Nye, C. (2003). [http://www.cochrane.org/CD004110/BEHAV_speech-and-language-therapy-interventions-for-children-with-primary-speech-and-language-delay-or-disorder Speech and language therapy interventions for children with primary speech and language delay or disorder (Cochrane Review)]. The Cochrane Library, 3.
-</ref> and so would not meet criteria for DLD. Where such problems continue beyond five years of age, they are usually accompanied by problems in broader language domains and have a poorer prognosis,<ref name=Bishop1987>Bishop, D. V. M., & Edmundson, A. (1987). [https://jshd.pubs.asha.org/article.aspx?articleid=1774916 Language-impaired four-year-olds: distinguishing transient from persistent impairment]. Journal of Speech and Hearing Disorders, 52, 156-173.
-</ref> so a diagnosis of DLD with SSD is then appropriate.
 [[File:Impairment overlaps.jpg|thumb|Developmental language disorder impairment compared to other common language related disorders]]
@@ Line 72: / Line 49: @@
 ==Risk factors==
+It is generally accepted that DLD is strongly influenced by genetic factors.<ref name=Bishop2006>{{cite journal |last1=Bishop |first1=Dorothy V M |title=What Causes Specific Language Impairment in Children? |journal=Current Directions in Psychological Science |date=October 2006 |volume=15 |issue=5 |pages=217–221 |doi=10.1111/j.1467-8721.2006.00439.x |pmc=2582396 }}</ref> The best evidence comes from the [[twin study]] method. Two twins growing up together are exposed to the same home environment, yet may differ radically in their language skills. Such different outcomes are, however, much more common in fraternal (non-identical) twins, who are genetically different. Identical twins share the same genes and tend to be much more similar in language ability. There can be some variation in the severity and persistence of DLD in identical twins, indicating that non-genetic factors affect the course of disorder, but it is unusual to find a child with DLD who has an identical twin with typical language.<ref>{{cite journal |last1=Bishop |first1=D. V. M. |last2=North |first2=T. |last3=Donlan |first3=C. |title=GENETIC BASIS OF SPECIFIC LANGUAGE IMPAIRMENT: EVIDENCE FROM A TWIN STUDY |journal=Developmental Medicine & Child Neurology |date=12 November 2008 |volume=37 |issue=1 |pages=56–71 |doi=10.1111/j.1469-8749.1995.tb11932.x }}</ref>
-It is generally accepted that DLD is strongly influenced by genetic factors.<ref name=Bishop2006>Bishop, D. V. M. (2006). [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582396/ What causes specific language impairment in children?] Current Directions in Psychological Science, 15, 217-221.
-</ref> The best evidence comes from the [[twin study]] method. Two twins growing up together are exposed to the same home environment, yet may differ radically in their language skills. Such different outcomes are, however, much more common in fraternal (non-identical) twins, who are genetically different. Identical twins share the same genes and tend to be much more similar in language ability. There can be some variation in the severity and persistence of DLD in identical twins, indicating that non-genetic factors affect the course of disorder, but it is unusual to find a child with DLD who has an identical twin with typical language.<ref>Bishop, D. V. M., North, T., & Donlan, C. (1995). [http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.1995.tb11932.x/abstract Genetic basis of specific language impairment: evidence from a twin study]. Developmental Medicine and Child Neurology, 37, 56-71.
-</ref>
 There was considerable excitement when a large, multigenerational family with a high rate of DLD were found to have a mutation of the [[FOXP2]] gene just in the affected family members.<ref>Fisher, S. E., Vargha Khadem, F., Watkins, K. E., Monaco, A. P., & Pembrey, M. E. (1998). [https://www.nature.com/ng/journal/v18/n2/abs/ng0298-168.html Localisation of a gene implicated in a severe speech and language disorder]. Nature Genetics, 18, 168-170.
-</ref> However, subsequent studies have found that, though DLD runs in families, it is not usually caused by a mutation in FOXP2 or another specific gene.<ref>Fisher, S. E. (2006). [http://www.sciencedirect.com/science/article/pii/S0010027706000746?via%3Dihub Tangled webs: Tracing the connections between genes and cognition]. Cognition, 101(2), 270-297. doi:10.1016/j.cognition.2006.04.004
+</ref> However, subsequent studies have found that, though DLD runs in families, it is not usually caused by a mutation in FOXP2 or another specific gene.<ref>{{cite journal |last1=Fisher |first1=S |title=Tangled webs: Tracing the connections between genes and cognition |journal=Cognition |date=September 2006 |volume=101 |issue=2 |pages=270–297 |doi=10.1016/j.cognition.2006.04.004 }}</ref> Current evidence suggests that there are many different genes that can influence language learning, and DLD results when a child inherits a particularly detrimental combination of risk factors, each of which may have only a small effect.<ref name=Bishop2006/> Nevertheless, study of the mode of action of the FOXP2 gene has helped identify other common genetic variants involved in the same neural pathways that may play a part in causing DLD.<ref>{{cite journal |last1=Fisher |first1=Simon E. |last2=Scharff |first2=Constance |title=FOXP2 as a molecular window into speech and language |journal=Trends in Genetics |date=April 2009 |volume=25 |issue=4 |pages=166–177 |doi=10.1016/j.tig.2009.03.002 }}</ref>
-</ref> Current evidence suggests that there are many different genes that can influence language learning, and DLD results when a child inherits a particularly detrimental combination of risk factors, each of which may have only a small effect.<ref name=Bishop2006/> Nevertheless, study of the mode of action of the FOXP2 gene has helped identify other common genetic variants involved in the same neural pathways that may play a part in causing DLD.<ref>Fisher, S. E., & Scharff, C. (2009). [http://www.cell.com/genetics/abstract/S0168-9525(09)00043-2 FOXP2 as a molecular window into speech and language]. Trends in genetics, 25(4), 166-177. doi:10.1016/j.tig.2009.03.002</ref>
-Language disorders are associated with aspects of home environment, and it is often assumed that this is a causal link, with poor language stimulation leading to weak language skills. Twin studies, however, show that two children in the same home environment can have very different language outcomes, suggesting we should consider other explanations for the link. Children with DLD often grow up into adults who have relatively low educational attainments,<ref>Whitehouse, A. J. O., Watt, H. J., Line, E. A., & Bishop, D. V. M. (2009). [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835860/ Adult psychosocial outcomes of children with specific language impairment, pragmatic language impairment and autism]. International Journal of Language and Communication Disorders, 44, 511-528.
+Language disorders are associated with aspects of home environment, and it is often assumed that this is a causal link, with poor language stimulation leading to weak language skills. Twin studies, however, show that two children in the same home environment can have very different language outcomes, suggesting we should consider other explanations for the link. Children with DLD often grow up into adults who have relatively low educational attainments,<ref>{{cite journal |last1=Whitehouse |first1=Andrew J O |last2=Watt |first2=Helen J |last3=Line |first3=E A |last4=Bishop |first4=Dorothy V M |title=Adult psychosocial outcomes of children with specific language impairment, pragmatic language impairment and autism |journal=International Journal of Language & Communication Disorders |date=2009 |volume=44 |issue=4 |pages=511–528 |doi=10.1080/13682820802708098 |pmc=2835860 }}</ref> and their children may share a genetic risk for language disorder.<ref name=Bishop2014 />
-</ref> and their children may share a genetic risk for language disorder.<ref name=Bishop2014 />
-One non-genetic factor that is known to have a specific impact on language development is being a younger sibling in a large family.<ref>Fundudis, T., Kolvin, I., & Garside, R. (1979). Speech Retarded and Deaf Children: Their Psychological Development. London: Academic Press.
+One non-genetic factor that is known to have a specific impact on language development is being a younger sibling in a large family.<ref>Fundudis, T., Kolvin, I., & Garside, R. (1979). Speech Retarded and Deaf Children: Their Psychological Development. London: Academic Press.{{pn}}</ref>
-</ref>
 ===Associated factors===
-It has long been noted that males are more affected by DLD than females, with a sex ratio of affected males: females around 3 or 4:1 <ref>Robinson, R. J. (1991). [http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.1991.tb14811.x/abstract Causes and associations of severe and persistent specific speech and language disorders in children]. Developmental Medicine and Child Neurology, 33, 943–962.</ref> However, the sex difference is much less striking in epidemiological samples, suggesting that similar problems may exist in females but are less likely to be detected.<ref name=Norbury2016 /> The reason for the sex difference is not well understood.
+It has long been noted that males are more affected by DLD than females, with a sex ratio of affected males: females around 3 or 4:1.<ref>{{cite journal |last1=Robinson |first1=Roger J. |title=CAUSES AND ASSOCIATIONS OF SEVERE AND PERSISTENT SPECIFIC SPEECH AND LANGUAGE DISORDERS IN CHILDREN |journal=Developmental Medicine & Child Neurology |date=12 November 2008 |volume=33 |issue=11 |pages=943–962 |doi=10.1111/j.1469-8749.1991.tb14811.x }}</ref> However, the sex difference is much less striking in epidemiological samples, suggesting that similar problems may exist in females but are less likely to be detected.<ref name=Norbury2016 /> The reason for the sex difference is not well understood.
-Poor motor skills are commonly found in children with DLD.<ref>Hill EL (2001). [http://onlinelibrary.wiley.com/doi/10.1080/13682820010019874/abstract Non-specific nature of specific language impairment: a review of the literature with regard to concomitant motor impairments.] International Journal of Language and Communication Disorders, 36 (2): 149–71. doi:10.1080/13682820010019874. {{PMID|11344592}}</ref> Standardized measures of motor ability confirm that children with DLD exhibit deficits in fine and gross motor skill, both simple and complex. These difficulties also extend to speech-motor ability, particularly with the control of their articulatory movements. Children with DLD have difficulty with motor sequence learning and may show deficits in other procedural motor processes as well.<ref>{{cite journal |last1=Sanjeevan |first1=T |last2=Rosenbaum |first2=D.A. |last3=Miller |first3=C |last4=Hell |first4=J.G.V |last5=Weiss |first5=D.J |last6=Mainela-Arnold |first6=E |title=Motor Issues in Specific Language Impairment: a Window into the Underlying Impairment. Current Developmental Disorders |journal=2(3), 228–236 |doi=10.1007/s40474-015-0051-9}}</ref>
+Poor motor skills are commonly found in children with DLD.<ref>{{cite journal |last1=Hill |first1=Elisabeth L. |title=Non-specific nature of specific language impairment: a review of the literature with regard to concomitant motor impairments |journal=International Journal of Language & Communication Disorders |date=January 2001 |volume=36 |issue=2 |pages=149–171 |doi=10.1080/13682820010019874 |pmid=11344592 }}</ref> Standardized measures of motor ability confirm that children with DLD exhibit deficits in fine and gross motor skill, both simple and complex. These difficulties also extend to speech-motor ability, particularly with the control of their articulatory movements. Children with DLD have difficulty with motor sequence learning and may show deficits in other procedural motor processes as well.<ref>{{cite journal |last1=Sanjeevan |first1=T |last2=Rosenbaum |first2=D.A. |last3=Miller |first3=C |last4=Hell |first4=J.G.V |last5=Weiss |first5=D.J |last6=Mainela-Arnold |first6=E |title=Motor Issues in Specific Language Impairment: a Window into the Underlying Impairment. Current Developmental Disorders |journal=2(3), 228–236 |doi=10.1007/s40474-015-0051-9}}</ref>
-Brain scans do not usually reveal any obvious abnormalities in children with DLD, although quantitative comparisons have found differences in brain size or relative proportions of white or grey matter in specific regions. In some cases, unusual brain gyri are found. To date, no consistent 'neural signature' for DLD has been found, although some studies have noted evidence for involvement of subcortical systems.<ref>Krishnan, S., Watkins, K., & Bishop, D. V. M. (2016). [http://www.sciencedirect.com/science/article/pii/S1364661316300833 Neurobiological basis of language learning difficulties]. Trends in Cognitive Sciences, 20(9), 701-714. doi:10.1016/j.tics.2016.06.012
+Brain scans do not usually reveal any obvious abnormalities in children with DLD, although quantitative comparisons have found differences in brain size or relative proportions of white or grey matter in specific regions. In some cases, unusual brain gyri are found. To date, no consistent 'neural signature' for DLD has been found, although some studies have noted evidence for involvement of subcortical systems.<ref>{{cite journal |last1=Krishnan |first1=Saloni |last2=Watkins |first2=Kate E. |last3=Bishop |first3=Dorothy V.M. |title=Neurobiological Basis of Language Learning Difficulties |journal=Trends in Cognitive Sciences |date=September 2016 |volume=20 |issue=9 |pages=701–714 |doi=10.1016/j.tics.2016.06.012 }}</ref> Differences in the brains of children with DLD vs typically developing children are subtle and may overlap with atypical patterns seen in other neurodevelopmental disorders.<ref>{{cite journal |last1=Herbert |first1=Martha R. |last2=Kenet |first2=Tal |title=Brain Abnormalities in Language Disorders and in Autism |journal=Pediatric Clinics of North America |date=June 2007 |volume=54 |issue=3 |pages=563–583 |doi=10.1016/j.pcl.2007.02.007 |pmid=17543910 }}</ref>
-</ref> Differences in the brains of children with DLD vs typically developing children are subtle and may overlap with atypical patterns seen in other neurodevelopmental disorders.<ref>Herbert MR, Kenet T (2007). [http://www.sciencedirect.com/science/article/pii/S0031395507000363 Brain abnormalities in language disorders and in autism.] Pediatric Clinics of North America, 54 (3): 563–83, vii. doi:10.1016/j.pcl.2007.02.007. {{PMID|17543910}}.
-</ref>
 ==Diagnosis==
@@ Line 101: / Line 71: @@
 # The problems are not associated with a known biomedical condition such as brain injury, neurodegenerative conditions, genetic conditions or chromosome disorders such as [[Down Syndrome|Down syndrome]], sensorineural hearing loss, or autism spectrum disorder or intellectual disability.
-For research and epidemiological purposes, specific cutoffs on language assessments have been used to document the first criterion. Tomblin et al.<ref>Tomblin, J. B., Records, N. L., & Zhang, X. (1996). [http://jslhr.pubs.asha.org/article.aspx?articleid=1781254 A system for the diagnosis of Specific Language Impairment in kindergarten children]. Journal of Speech, Language, and Hearing Research, 39(6), 1284. doi:10.1044/jshr.3906.1284
+For research and epidemiological purposes, specific cutoffs on language assessments have been used to document the first criterion. Tomblin et al.<ref>{{cite journal |last1=Tomblin |first1=J. Bruce |last2=Records |first2=Nancy L. |last3=Zhang |first3=Xuyang |title=A System for the Diagnosis of Specific Language Impairment in Kindergarten Children |journal=Journal of Speech, Language, and Hearing Research |date=December 1996 |volume=39 |issue=6 |pages=1284–1294 |doi=10.1044/jshr.3906.1284 }}</ref> proposed the EpiSLI criterion, based on five composite scores representing performance in three domains of language (vocabulary, grammar, and narration) and two modalities (comprehension and production). Children scoring in the lowest 10% on two or more composite scores are identified as having language disorder.
-</ref> proposed the EpiSLI criterion, based on five composite scores representing performance in three domains of language (vocabulary, grammar, and narration) and two modalities (comprehension and production). Children scoring in the lowest 10% on two or more composite scores are identified as having language disorder.
 The second criterion, persistence of language problems, can be difficult to judge in a young child, but longitudinal studies have shown that difficulties are less likely to resolve for children who have poor language comprehension, rather than difficulties confined to expressive language.<ref name=Bishop2017 /> In addition, children with isolated difficulties in just one of the areas noted under 'subtypes' tend to make better progress than those whose language is impaired in several areas.<ref name=Bishop1987 />
-The third criterion specifies that DLD is used for children whose language disorder is not part of another biomedical condition, such as a genetic syndrome, a sensorineural hearing loss, neurological disease, autism spectrum disorder or intellectual disability – these were termed 'differentiating conditions' by the CATALISE panel.<ref name=Bishop2017 /> Language disorders occurring with these conditions need to be assessed and children offered appropriate intervention, but a terminological distinction is made so that these cases would be diagnosed as language disorder associated with the main diagnosis being specified: e.g. "language disorder associated with autism spectrum disorder." The reasoning behind these diagnostic distinctions is discussed further by Bishop (2017).<ref>{{cite journal|year=2017|title=Why is it so hard to reach agreement on terminology? The case of developmental language disorder (DLD)|journal=International Journal of Language & Communication Disorders|volume=52|issue=6|pages=671–680|doi=10.1111/1460-6984.12335|pmid=28714100|pmc=5697617|author-last=Bishop|author-first=D. V. M.}}</ref>
+The third criterion specifies that DLD is used for children whose language disorder is not part of another biomedical condition, such as a genetic syndrome, a sensorineural hearing loss, neurological disease, autism spectrum disorder or intellectual disability – these were termed 'differentiating conditions' by the CATALISE panel.<ref name=Bishop2017 /> Language disorders occurring with these conditions need to be assessed and children offered appropriate intervention, but a terminological distinction is made so that these cases would be diagnosed as language disorder associated with the main diagnosis being specified: e.g. "language disorder associated with autism spectrum disorder." The reasoning behind these diagnostic distinctions is discussed further by Bishop (2017).<ref>{{cite journal |last1=Bishop |first1=Dorothy V. M. |title=Why is it so hard to reach agreement on terminology? The case of developmental language disorder (DLD) |journal=International Journal of Language & Communication Disorders |date=November 2017 |volume=52 |issue=6 |pages=671–680 |doi=10.1111/1460-6984.12335 |pmid=28714100 }}</ref>
 ====Benchmarks for children with Developmental Language Disorder ====
@@ Line 144: / Line 113: @@
 ===Assessment===
-Assessment will usually include an interview with the child’s caregiver, observation of the child in an unstructured setting, a hearing test, and standardized tests of language.<ref>Paul, R. (2006). Language Disorders from Infancy through Adolescence: Assessment and Intervention, 3rd Edition. St. Louis: Mosby-Year Book.
+Assessment will usually include an interview with the child’s caregiver, observation of the child in an unstructured setting, a hearing test, and standardized tests of language.<ref>Paul, R. (2006). Language Disorders from Infancy through Adolescence: Assessment and Intervention, 3rd Edition. St. Louis: Mosby-Year Book.{{pn}}</ref> There is a wide range of language assessments in English. Some are restricted for use by experts in [[speech-language pathology]]: speech and language therapists (SaLTs/SLTs) in the UK, speech-language pathologists (SLPs) in the US and Australia. A commonly used test battery for diagnosis of DLD is the [http://www.pearsonclinical.co.uk/Psychology/ChildCognitionNeuropsychologyandLanguage/ChildLanguage/ClinicalEvaluationofLanguageFundamentals-FourthEditionUK(CELF-4UK)/ClinicalEvaluationofLanguageFundamentals-FourthEditionUK(CELF-4UK).aspx Clinical Evaluation of Language Fundamentals (CELF)].
-</ref> There is a wide range of language assessments in English. Some are restricted for use by experts in [[speech-language pathology]]: speech and language therapists (SaLTs/SLTs) in the UK, speech-language pathologists (SLPs) in the US and Australia. A commonly used test battery for diagnosis of DLD is the [http://www.pearsonclinical.co.uk/Psychology/ChildCognitionNeuropsychologyandLanguage/ChildLanguage/ClinicalEvaluationofLanguageFundamentals-FourthEditionUK(CELF-4UK)/ClinicalEvaluationofLanguageFundamentals-FourthEditionUK(CELF-4UK).aspx Clinical Evaluation of Language Fundamentals (CELF)].
 Assessments that can be completed by a parent or teacher can be useful to identify children who may require more in-depth evaluation. The [http://www.pearsonclinical.co.uk/Psychology/ChildCognitionNeuropsychologyandLanguage/ChildLanguage/ChildrensCommunicationChecklist(CCC-2)/ChildrensCommunicationChecklist(CCC-2).aspx Children’s Communication Checklist (CCC–2)] is a parent questionnaire suitable for assessing everyday use of language in children aged four years and above who can speak in sentences.
 Informal assessments, such as language samples, are often used by speech-language therapists/pathologists to complement formal testing and give an indication of the child's language in a more naturalistic context. A language sample may be of a conversation or narrative retell. In a narrative language sample, an adult may tell the child a story using a wordless picture book (e.g. [https://books.google.co.uk/books/about/Frog_Where_Are_You.html?id=Asi5KQAACAAJ&hl=en Frog Where Are You?, Mayer, 1969]), then ask the child to use the pictures and tell the story back. Language samples can be transcribed using computer software such as the [http://www.saltsoftware.com/ Systematic Analysis of Language Software], and then analyzed for a range of features: e.g., the grammatical complexity of the child's utterances,  whether the child introduces characters to their story or jumps right in, whether the events follow a logical order, and whether the narrative includes a main idea or theme and supporting details.
 ==Treatment==
-Treatment is usually carried out by speech and language therapists/pathologists, who use a wide range of techniques to stimulate language learning.<ref>Roth, F. P., & Worthington, C. K. (2010). Treatment resource manual for speech-language pathology, 4th edition. San Diego: Singular Publishing.</ref> In the past, there was a vogue for drilling children in grammatical exercises, using imitation and elicitation, but such methods fell into disuse when it became apparent that there was little generalisation to everyday situations. Contemporary approaches to enhancing development of language structure, for younger children at least, are more likely to adopt 'milieu' methods, in which the intervention is interwoven into natural episodes of communication, and the therapist builds on the child's utterances, rather than dictating what will be talked about. Interventions for older children, may be more explicit, telling the children what areas are being targeted and giving explanations regarding the rules and structures they are learning, often with visual supports.<ref>Ebbels, S.H., [http://journals.sagepub.com/doi/abs/10.1191/0265659007072143?journalCode=clta Teaching grammar to school-aged children with Specific Language Impairment using Shape Coding]. Child Language Teaching and Therapy, 2007. 23(1): p. 67-93.</ref><ref>Bryan, A., Colourful Semantics., in Language disorders in children and adults: psycholinguistic approaches to therapy., S. Chiat, J. Law, and J. Marshall, Editors. 1997, Whurr: London</ref>
+Treatment is usually carried out by speech and language therapists/pathologists, who use a wide range of techniques to stimulate language learning.<ref>Roth, F. P., & Worthington, C. K. (2010). Treatment resource manual for speech-language pathology, 4th edition. San Diego: Singular Publishing.{{pn}}</ref> In the past, there was a vogue for drilling children in grammatical exercises, using imitation and elicitation, but such methods fell into disuse when it became apparent that there was little generalisation to everyday situations. Contemporary approaches to enhancing development of language structure, for younger children at least, are more likely to adopt 'milieu' methods, in which the intervention is interwoven into natural episodes of communication, and the therapist builds on the child's utterances, rather than dictating what will be talked about. Interventions for older children, may be more explicit, telling the children what areas are being targeted and giving explanations regarding the rules and structures they are learning, often with visual supports.<ref>{{cite journal |last1=Ebbels |first1=Susan |title=Teaching grammar to school-aged children with specific language impairment using Shape Coding |journal=Child Language Teaching and Therapy |date=25 July 2016 |volume=23 |issue=1 |pages=67–93 |doi=10.1191/0265659007072143 }}</ref><ref>Bryan, A., Colourful Semantics., in Language disorders in children and adults: psycholinguistic approaches to therapy., S. Chiat, J. Law, and J. Marshall, Editors. 1997, Whurr: London{{pn}}</ref>
-In addition, there has been a move away from a focus solely on grammar and phonology toward interventions that develop children's social use of language, often working in small groups that may include typically developing as well as language-impaired peers.<ref>1.	Gallagher, T. (1996). Social-interactional approaches to child language intervention. In J. Beitchman, N. J. Cohen, M. M. Konstantareas & R. Tannock (Eds.), Language, Learning and Behavior Disorders: Developmental, Biological and Clinical Perspectives (pp. 493–514). New York: Cambridge University Press.
+In addition, there has been a move away from a focus solely on grammar and phonology toward interventions that develop children's social use of language, often working in small groups that may include typically developing as well as language-impaired peers.<ref>{{cite book |last1=Gallagher |first1=Tanya M. |chapter=Social-interactional approaches to child language intervention |pages=418–435 |chapterurl={{Google books|p6oMOaOom1sC|page=418|plainurl=yes}} |editor1-last=Beitchman |editor1-first=Joseph H. |editor2-last=Cohen |editor2-first=Nancy J. |editor3-last=Konstantareas |editor3-first=M. Mary |editor4-last=Tannock |editor4-first=Rosemary |title=Language, Learning, and Behavior Disorders: Developmental, Biological, and Clinical Perspectives |date=1996 |publisher=Cambridge University Press |isbn=978-0-521-47229-6 }}</ref>
-</ref>
-Another way in contemporary remediation differ from the past is that parents are more likely to be directly involved, but this approach is largely used with preschool children, rather than those whose problems persist into school age.<ref>Roberts, M.Y. and A.P. Kaiser (2011) [http://ajslp.pubs.asha.org/article.aspx?articleid=1757532 The effectiveness of parent-implemented language interventions: A meta-analysis]. American Journal of Speech-Language Pathology, 20(3), 180-199</ref><ref>Tosh, R., W. Arnott, and N. Scarinci, [http://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12280/abstract Parent-implemented home therapy programs for speech and language: A systematic review]. International Journal of Language & Communication Disorders, 2017.</ref>
+Another way in contemporary remediation differ from the past is that parents are more likely to be directly involved, but this approach is largely used with preschool children, rather than those whose problems persist into school age.<ref>{{cite journal |title=The Effectiveness of Parent-Implemented Language Interventions: A Meta-Analysis |journal=American Journal of Speech-Language Pathology |date=1 August 2011 |volume=20 |issue=3 |pages=180–199 |doi=10.1044/1058-0360(2011/10-0055) }}</ref><ref>{{cite journal |last1=Tosh |first1=Rachel |last2=Arnott |first2=Wendy |last3=Scarinci |first3=Nerina |title=Parent-implemented home therapy programmes for speech and language: a systematic review |journal=International Journal of Language & Communication Disorders |date=May 2017 |volume=52 |issue=3 |pages=253–269 |doi=10.1111/1460-6984.12280 }}</ref>
-For school-aged children, teachers are increasingly involved in intervention, either in collaboration with speech and language therapists/pathologists, or as the main agents of delivery of the intervention. Evidence for the benefits of a collaborative approach is emerging,<ref>Archibald, L.(2017). [http://journals.sagepub.com/doi/full/10.1177/2396941516680369 SLP-Educator classroom collaboration: A review to inform reason-based practice.] Autism and Developmental Language Impairments, 2. DOI: https://doi.org/10.1177/2396941516680369</ref> but the benefits of asking education staff to be the main deliverers of SLT intervention (the “consultative” approach) are unclear.<ref>McCartney, E., et al., [http://onlinelibrary.wiley.com/doi/10.3109/13682820903560302/abstract Indirect language therapy for children with persistent language impairment in mainstream primary schools: outcomes from a cohort intervention]. International Journal of Language & Communication Disorders, 2011. 46(1), 74-82.</ref> When SLT intervention is delivered indirectly by trained SLT assistants, however, there are indications that this can be effective.<ref>Mecrow, C., J. Beckwith, and T. Klee, An exploratory trial of the effectiveness of an enhanced consultative approach to delivering speech and language intervention in schools. International Journal of Language & Communication Disorders, 2010. 45(3): p. 354-367. DOI: 10.3109/13682820903560302</ref>
+For school-aged children, teachers are increasingly involved in intervention, either in collaboration with speech and language therapists/pathologists, or as the main agents of delivery of the intervention. Evidence for the benefits of a collaborative approach is emerging,<ref>{{cite journal |last1=Archibald |first1=Lisa MD |title=SLP-educator classroom collaboration: A review to inform reason-based practice |journal=Autism & Developmental Language Impairments |date=January 2017 |volume=2 |doi=10.1177/2396941516680369 }}</ref> but the benefits of asking education staff to be the main deliverers of SLT intervention (the “consultative” approach) are unclear.<ref>{{cite journal |last1=McCartney |first1=Elspeth |last2=Boyle |first2=James |last3=Ellis |first3=Sue |last4=Bannatyne |first4=Susan |last5=Turnbull |first5=Mary |title=Indirect language therapy for children with persistent language impairment in mainstream primary schools: outcomes from a cohort intervention |journal=International Journal of Language & Communication Disorders |date=26 March 2010 |doi=10.3109/13682820903560302 }}</ref> When SLT intervention is delivered indirectly by trained SLT assistants, however, there are indications that this can be effective.<ref>{{cite journal |last1=McCartney |first1=Elspeth |last2=Boyle |first2=James |last3=Ellis |first3=Sue |last4=Bannatyne |first4=Susan |last5=Turnbull |first5=Mary |title=Indirect language therapy for children with persistent language impairment in mainstream primary schools: outcomes from a cohort intervention |journal=International Journal of Language & Communication Disorders |date=26 March 2010 |doi=10.3109/13682820903560302 }}</ref>
-In this field, [[randomized controlled trial]] methodology has not been widely used, and this makes it difficult to assess clinical efficacy with confidence. Children's language will tend to improve over time, and without controlled studies, it can be hard to know how much of observed change is down to a specific treatment. There is, however, increasing evidence that direct 1:1 intervention with an SLT/P can be effective for improving vocabulary and expressive language.<ref>Law, J., Garrett, Z., & Nye, C. (2004). [https://jslhr.pubs.asha.org/article.aspx?articleid=1781483 The efficacy of treatment for children with developmental speech and language delay/disorder: a meta-analysis]. Journal of Speech, Language, and Hearing Research, 47, 924-943
+In this field, [[randomized controlled trial]] methodology has not been widely used, and this makes it difficult to assess clinical efficacy with confidence. Children's language will tend to improve over time, and without controlled studies, it can be hard to know how much of observed change is down to a specific treatment. There is, however, increasing evidence that direct 1:1 intervention with an SLT/P can be effective for improving vocabulary and expressive language.<ref>{{cite journal |last1=Law |first1=James |last2=Garrett |first2=Zoe |last3=Nye |first3=Chad |title=The Efficacy of Treatment for Children With Developmental Speech and Language Delay/Disorder |journal=Journal of Speech, Language, and Hearing Research |date=August 2004 |volume=47 |issue=4 |pages=924–943 |doi=10.1044/1092-4388(2004/069) |pmid=15324296 }}</ref> There have been few studies of interventions that target receptive language,<ref>{{cite journal |last1=Boyle |first1=James |last2=McCartney |first2=Elspeth |last3=O'Hare |first3=Anne |last4=Law |first4=James |title=Intervention for mixed receptive-expressive language impairment: a review |journal=Developmental Medicine & Child Neurology |date=November 2010 |volume=52 |issue=11 |pages=994–999 |doi=10.1111/j.1469-8749.2010.03750.x }}</ref> though some positive outcomes have been reported.<ref>{{cite journal |last1=Ebbels |first1=Susan |title=Effectiveness of intervention for grammar in school-aged children with primary language impairments: A review of the evidence |journal=Child Language Teaching and Therapy |date=9 December 2013 |volume=30 |issue=1 |pages=7–40 |doi=10.1177/0265659013512321 }}</ref><ref>{{cite journal |last1=Ebbels |first1=Susan H. |last2=Marić |first2=Nataša |last3=Murphy |first3=Aoife |last4=Turner |first4=Gail |title=Improving comprehension in adolescents with severe receptive language impairments: a randomized control trial of intervention for coordinating conjunctions |journal=International Journal of Language & Communication Disorders |date=January 2014 |volume=49 |issue=1 |pages=30–48 |doi=10.1111/1460-6984.12047 }}</ref><ref>{{cite journal |last1=Ebbels |first1=Susan H. |last2=Wright |first2=Lisa |last3=Brockbank |first3=Sally |last4=Godfrey |first4=Caroline |last5=Harris |first5=Catherine |last6=Leniston |first6=Hannah |last7=Neary |first7=Kate |last8=Nicoll |first8=Hilary |last9=Nicoll |first9=Lucy |last10=Scott |first10=Jackie |last11=Marić |first11=Nataša |title=Effectiveness of 1:1 speech and language therapy for older children with (developmental) language disorder |journal=International Journal of Language & Communication Disorders |date=July 2017 |volume=52 |issue=4 |pages=528–539 |doi=10.1111/1460-6984.12297 }}</ref>
- doi:10.1044/1092-4388(2004/069) {{PMID|15324296}}.
-</ref> There have been few studies of interventions that target receptive language,<ref>Boyle, J., McCartney, E., O'Hare, A., & Law, J. (2010). [http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2010.03750.x/full Intervention for mixed receptive-expressive language impairment: a review]. Developmental Medicine and Child Neurology, 52(11), 994-999. doi:10.1111/j.1469-8749.2010.03750.x
-</ref> though some positive outcomes have been reported.<ref>Ebbels, S.H.(2014). [http://journals.sagepub.com/doi/pdf/10.1177/0265659013512321 Effectiveness of intervention for grammar in school-aged children with primary language impairments: A review of the evidence.] Child Language Teaching and Therapy, 30(1), 7-40.</ref><ref>Ebbels, S.H., et al., Improving comprehension in adolescents with severe receptive language impairments: a randomised control trial of intervention for coordinating conjunctions. International Journal of Language & Communication Disorders, 2014. 49(1): p. 30-48.</ref><ref>Ebbels, S.H. et al.(2017). [http://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12297/abstract Effectiveness of 1:1 speech and language therapy for older children with (developmental) language disorder]. International Journal of Language & Communication Disorders, 52(4), 528-539&nbsp;DOI: 10.1111/1460-6984.12297</ref>
 ==== How to help a child with Developmental Language Disorder ====
@@ Line 172: / Line 136: @@
 * Get the child to ask you questions.
 * Give the child time to answer questions.
-* Keep them in school. Children who are school-refusers have poorer language skills overall, and a higher incidence of language impairments <ref> Naylor, M. W., Staskowski, M., Kenney, M. C., & King, C. A. (1994). Language disorders and learning disabilities in school-refusing adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, http://doi.org/10.1044/1058-0360(2009/08-0083) </ref>
+* Keep them in school. Children who are school-refusers have poorer language skills overall, and a higher incidence of language impairments<ref>{{cite journal |last1=Johnson |first1=Carla J. |last2=Beitchman |first2=Joseph H. |last3=Brownlie |first3=E. B. |title=Twenty-Year Follow-Up of Children With and Without Speech-Language Impairments: Family, Educational, Occupational, and Quality of Life Outcomes |journal=American Journal of Speech-Language Pathology |date=February 2010 |volume=19 |issue=1 |pages=51–65 |doi=10.1044/1058-0360(2009/08-0083) }}</ref>
 ==Outcome==
-[[Longitudinal studies]] indicate that problems are largely resolved by five years of age in around 40% of four-year-olds with early language delays who have no other presenting risk factors.<ref name=Bishop1987 /> However, for children who still have significant language difficulties at school entry, reading problems are common, even for children who receive specialist help,<ref>Catts, H. W., Fey, M. E., Tomblin, J. B., & Zhang, X. (2002). [http://jslhr.pubs.asha.org/article.aspx?articleid=1781088 A longitudinal investigation of reading outcomes in children with language impairments]. Journal of Speech, Language and Hearing Research, 45, 1142-1157.
+[[Longitudinal studies]] indicate that problems are largely resolved by five years of age in around 40% of four-year-olds with early language delays who have no other presenting risk factors.<ref name=Bishop1987 /> However, for children who still have significant language difficulties at school entry, reading problems are common, even for children who receive specialist help,<ref>{{cite journal |title=A Longitudinal Investigation of Reading Outcomes in Children With Language Impairments |journal=Journal of Speech, Language, and Hearing Research |date=1 December 2002 |volume=45 |issue=6 |pages=1142–1157 |doi=10.1044/1092-4388(2002/093) }}</ref> and educational attainments are typically poor.<ref>{{cite journal |last1=Snowling |first1=Margaret J. |last2=Adams |first2=John W. |last3=Bishop |first3=D. V. M. |last4=Stothard |first4=Susan E. |title=Educational attainments of school leavers with a preschool history of speech-language impairments |journal=International Journal of Language & Communication Disorders |date=2001 |volume=36 |issue=2 |pages=173–183 |doi=10.1080/13682820120976 }}</ref> Poor outcomes are most common in cases where comprehension as well as expressive language is affected.<ref>{{cite journal |last1=Simkin |first1=Zoë |last2=Conti-Ramsden |first2=Gina |title=Evidence of reading difficulty in subgroups of children with specific language impairment |journal=Child Language Teaching and Therapy |date=26 July 2016 |volume=22 |issue=3 |pages=315–331 |doi=10.1191/0265659006ct310xx }}</ref> There is also evidence that scores on tests of nonverbal ability of children with DLD decrease over the course of development.<ref>{{cite journal |last1=Botting |first1=Nicola |title=Non-verbal cognitive development and language impairment |journal=Journal of Child Psychology and Psychiatry |date=March 2005 |volume=46 |issue=3 |pages=317–326 |doi=10.1111/j.1469-7610.2004.00355.x }}</ref>
-</ref> and educational attainments are typically poor.<ref>Snowling, M. J., Adams, J. W., Bishop, D. V. M., & Stothard, S. E. (2001). [http://onlinelibrary.wiley.com/doi/10.1080/13682820120976/abstract Educational attainments of school-leavers with a pre-school history of speech-language impairments]. International Journal of Language and Communication Disorders, 36, 173-183.
-</ref> Poor outcomes are most common in cases where comprehension as well as expressive language is affected.<ref>Simkin, Z., & Conti-Ramsden, G. (2006). [http://journals.sagepub.com/doi/abs/10.1191/0265659006ct310xx Evidence of reading difficulty in subgroups of children with specific language impairment]. Child Language Teaching and Therapy, 22, 315-331.
-</ref> There is also evidence that scores on tests of nonverbal ability of children with DLD decrease over the course of development.<ref>Botting, N. (2005). [http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2004.00355.x/abstract Non-verbal cognitive development and language impairment]. Journal of Child Psychology and Psychiatry, 46(3), 317-326. doi:10.1111/j.1469-7610.2004.00355.x</ref>
 DLD is associated with an elevated risk of social, emotional and mental health concerns.<ref>Cohen, Nancy (2001). Language impairment and psychopathology in infants, children, and adolescents. Thousand Oaks: Sage Publications. {{ISBN|0-7619-2025-0}}. OCLC&nbsp;45749780.
+</ref> For instance, in a UK survey, 64% of a sample of 11-year-olds with DLD scored above a clinical threshold on a questionnaire for psychiatric difficulties, and 36% were regularly bullied, compared with 12% of comparison children.<ref>{{cite journal |title=Social Difficulties and Victimization in Children With SLI at 11 Years of Age |journal=Journal of Speech, Language, and Hearing Research |date=1 February 2004 |volume=47 |issue=1 |pages=145–161 |doi=10.1044/1092-4388(2004/013) }}</ref> In the longer-term, studies of adult outcomes of children with DLD have found elevated rates of unemployment, social isolation and psychiatric disorder among those with early comprehension difficulties.<ref>{{cite journal |last1=Clegg |first1=J. |last2=Hollis |first2=C. |last3=Mawhood |first3=L. |last4=Rutter |first4=M. |title=Developmental language disorders - a follow-up in later adult life. Cognitive, language and psychosocial outcomes |journal=Journal of Child Psychology and Psychiatry |date=February 2005 |volume=46 |issue=2 |pages=128–149 |doi=10.1111/j.1469-7610.2004.00342.x }}</ref> However, better outcomes are found for children who have milder difficulties and do not require special educational provision.<ref>{{cite journal |last1=Snowling |first1=Margaret J. |last2=Bishop |first2=D.V.M. |last3=Stothard |first3=Susan E. |last4=Chipchase |first4=Barry |last5=Kaplan |first5=Carole |title=Psychosocial outcomes at 15 years of children with a preschool history of speech-language impairment |journal=Journal of Child Psychology and Psychiatry |date=9 June 2006 |volume=47 |issue=8 |pages=759–765 |doi=10.1111/j.1469-7610.2006.01631.x }}</ref>
-</ref> For instance, in a UK survey, 64% of a sample of 11-year-olds with DLD scored above a clinical threshold on a questionnaire for psychiatric difficulties, and 36% were regularly bullied, compared with 12% of comparison children.<ref>Conti-Ramsden, G., & Botting, N. (2004). [http://jslhr.pubs.asha.org/article.aspx?articleid=1781421 Social difficulties and victimization in children with SLI at 11 years of age.] Journal of Speech, Language, and Hearing Research, 47, 145-161.
-</ref> In the longer-term, studies of adult outcomes of children with DLD have found elevated rates of unemployment, social isolation and psychiatric disorder among those with early comprehension difficulties.<ref>Clegg, J., Hollis, C., Mawhood, L., & Rutter, M. (2005). [http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2004.00342.x/abstract Developmental language disorders - a follow-up in later life. Cognitive, language and psychosocial outcomes.] Journal of Child Psychology and Psychiatry, 46, 128-149.
-</ref> However, better outcomes are found for children who have milder difficulties and do not require special educational provision.<ref>Snowling, M. J., Bishop, D. V. M., Stothard, S. E., Chipchase, B., & Kaplan, C. (2006). [http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2006.01631.x/abstract Psychosocial outcomes at 15 years of children with a preschool history of speech-language impairment]. Journal of Child Psychology and Psychiatry, 47, 759-765.
-</ref>
 ==Prevalence==
+Epidemiological surveys, in the US<ref>{{cite journal |title=Prevalence of Specific Language Impairment in Kindergarten Children |journal=Journal of Speech, Language, and Hearing Research |date=1 December 1997 |volume=40 |issue=6 |pages=1245–1260 |doi=10.1044/jslhr.4006.1245 }}</ref> and the UK<ref name=Norbury2016>{{cite journal |last1=Norbury |first1=Courtenay Frazier |last2=Gooch |first2=Debbie |last3=Wray |first3=Charlotte |last4=Baird |first4=Gillian |last5=Charman |first5=Tony |last6=Simonoff |first6=Emily |last7=Vamvakas |first7=George |last8=Pickles |first8=Andrew |title=The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study |journal=Journal of Child Psychology and Psychiatry |date=November 2016 |volume=57 |issue=11 |pages=1247–1257 |doi=10.1111/jcpp.12573 }}</ref> converge in estimating the prevalence of DLD in five-year-olds at around 7%. Therefore, the prevalence is one in every 15 children.  By these statistics, in a classroom of 30 students, 2 would have DLD.<ref name="Kuiack et al 2019"/> In research by Tomblin et al. prevalence of [DLD] in racial/ethnic groups was highest in Native Americans, with African Americans being the next highest, followed by Hispanics, and then Whites.<ref>{{cite journal |last1=Tomblin |first1=J. Bruce |last2=Records |first2=Nancy L. |last3=Buckwalter |first3=Paula |last4=Zhang |first4=Xuyang |last5=Smith |first5=Elaine |last6=O’Brien |first6=Marlea |title=Prevalence of Specific Language Impairment in Kindergarten Children |journal=Journal of speech, language, and hearing research |date=December 1997 |volume=40 |issue=6 |pages=1245–1260 |pmc=5075245 }}</ref> No students of Asian descent presented with [DLD]; however, other research does indicate that [DLD] is present in children of Asian descent).
-Epidemiological surveys, in the US<ref>Tomblin, J. B., Records, N. L., Buckwalter, P., Zhang, X., Smith, E., & O'Brien, M. (1997). [http://jslhr.pubs.asha.org/article.aspx?articleid=1781924 Prevalence of specific language impairment in kindergarten children]. Journal of Speech and Hearing Research, 40(6), 1245-1260.
-</ref> and the UK<ref name=Norbury2016>Norbury, C. F., Gooch, D., Wray, C., Baird, G., Charman, T., Simonoff, E., . . . Pickles, A. (2016). [http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12573/full The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study.] Journal of Child Psychology and Psychiatry, n/a-n/a. doi:10.1111/jcpp.12573
-</ref> converge in estimating the prevalence of DLD in five-year-olds at around 7%. Therefore, the prevalence is one in every 15 children.  By these statistics, in a classroom of 30 students, 2 would have DLD. <ref> Michelle Kennedy et al.. Developmental Language Disorder: The Childhood Condition We Need to Start Talking About. Retrieved from https://kids.frontiersin.org/article> </ref> In research by Tomblin et al. prevalence of [DLD] in racial/ethnic groups was highest in Native Americans, with African Americans being the next highest, followed by Hispanics, and then Whites.<ref> Tomblin, J. B., Records, N. L., Buckwalter, P., Zhang, X., Smith, E., & O'Brien, M. (1997, December). Prevalence of specific language impairment in kindergarten children. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075245 </ref> No students of Asian descent presented with [DLD]; however, other research does indicate that [DLD] is present in children of Asian descent).
 ==Research==
 Much research has focused on trying to identify what makes language learning so hard for some children.<ref>Bishop, D. V. M. (1997). Uncommon Understanding: Development and Disorders of Language Comprehension in Children. Hove: Psychology Press.
+</ref> A major divide is between theories that attribute the difficulties to a low-level problem with auditory temporal processing, and those that propose there is a deficit in a specialised language-learning system.<ref>{{cite journal |title=Specific Language Impairment as a Period of Extended Optional Infinitive |journal=Journal of Speech, Language, and Hearing Research |date=1 August 1995 |volume=38 |issue=4 |pages=850–863 |doi=10.1044/jshr.3804.850 }}</ref><ref>{{cite journal |last1=van der Lely |first1=Heather K.J. |title=Domain-specific cognitive systems: insight from Grammatical-SLI |journal=Trends in Cognitive Sciences |date=February 2005 |volume=9 |issue=2 |pages=53–59 |doi=10.1016/j.tics.2004.12.002 }}</ref> Other accounts emphasise deficits in specific aspects of learning and memory.<ref>{{cite journal |last1=Gathercole |first1=Susan E |last2=Baddeley |first2=Alan D |title=Phonological memory deficits in language disordered children: Is there a causal connection? |journal=Journal of Memory and Language |date=1 June 1990 |volume=29 |issue=3 |pages=336–360 |doi=10.1016/0749-596X(90)90004-J }}</ref><ref>{{cite journal |last1=Ullman |first1=Michael T. |last2=Pierpont |first2=Elizabeth I. |title=Specific Language Impairment is not Specific to Language: the Procedural Deficit Hypothesis |journal=Cortex |date=1 January 2005 |volume=41 |issue=3 |pages=399–433 |doi=10.1016/S0010-9452(08)70276-4 }}</ref> It can be difficult to choose between theories because they do not always make distinctive predictions, and there is considerable heterogeneity among children with DLD. It has also been suggested that DLD may only arise when more than one underlying deficit is present.<ref>{{cite journal |last1=Bishop |first1=Dorothy V. M. |title=Developmental cognitive genetics: How psychology can inform genetics and vice versa |journal=Quarterly Journal of Experimental Psychology (2006) |date=2006 |volume=59 |issue=7 |pages=1153–1168 |doi=10.1080/17470210500489372 |pmc=2409179 }}</ref>
-</ref> A major divide is between theories that attribute the difficulties to a low-level problem with auditory temporal processing, and those that propose there is a deficit in a specialised language-learning system.<ref>Rice, M. L., Wexler, K., & Cleave, P. L. (1995). [http://jslhr.pubs.asha.org/article.aspx?articleid=1780857 Specific language impairment as a period of extended optional infinitive]. Journal of Speech and Hearing Research, 38, 850-863.
-</ref><ref>Van der Lely, H. K. J. (2005). [http://www.cell.com/trends/cognitive-sciences/fulltext/S1364-6613(04)00296-7?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1364661304002967%3Fshowall%3Dtrue Domain-specific cognitive systems: insight from Grammatical-SLI]. Trends in Cognitive Sciences, 9, 53-59.
-</ref> Other accounts emphasise deficits in specific aspects of learning and memory.<ref>Gathercole, S. E., & Baddeley, A. D. (1990). [http://www.sciencedirect.com/science/article/pii/0749596X9090004J Phonological memory deficits in language disordered children: is there a causal connection?] Journal of Memory and Language, 29, 336-360.
-</ref><ref>Ullman, M. T., & Pierpont, E. I. (2005). [http://www.sciencedirect.com/science/article/pii/S0010945208702764|Specific language impairment is not specific to language: The procedural deficit hypothesis]. Cortex, 41, 399-433.
-</ref> It can be difficult to choose between theories because they do not always make distinctive predictions, and there is considerable heterogeneity among children with DLD. It has also been suggested that DLD may only arise when more than one underlying deficit is present.<ref>Bishop, D. V. M. (2006). [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409179/ Developmental cognitive genetics: How psychology can inform genetics and vice versa]. Quarterly Journal of Experimental Psychology, 59, 1153-1168.
-</ref>
 ==== Developmental learning disorder in adults ====
-Relatively little research has been conducted to test the outcomes of DLD in adults. In a study comparing 17 men with DLD to their non language disordered siblings, researchers found that The DLD men had normal intelligence with higher performance IQ than verbal IQ. The participants still exhibited a severe and persisting language disorder, severe literacy impairments and significant deficits in theory of mind and phonological processing. Within the DLD cohort higher childhood intelligence and language were associated with superior cognitive and language ability at final adult outcome. In their mid-thirties, the DLD cohort had significantly worse social adaptation (with prolonged unemployment and a paucity of close friendships and love relationships) compared with both their siblings and NCDS controls. Self-reports showed a higher rate of schizotypal features but not affective disorder. Four DLD adults had serious mental health problems (two had developed schizophrenia). <ref> Clegg, J., Hollis, C., Mawhood, L., & Rutter, M. (2005). Developmental language disorders - a follow-up in later adult life. Cognitive, language and psychosocial outcomes. Journal of Child Psychology and Psychiatry, 46(2), 128–149. doi: 10.1111/j.1469-7610.2004.00342.x </ref>
+Relatively little research has been conducted to test the outcomes of DLD in adults. In a study comparing 17 men with DLD to their non language disordered siblings, researchers found that The DLD men had normal intelligence with higher performance IQ than verbal IQ. The participants still exhibited a severe and persisting language disorder, severe literacy impairments and significant deficits in theory of mind and phonological processing. Within the DLD cohort higher childhood intelligence and language were associated with superior cognitive and language ability at final adult outcome. In their mid-thirties, the DLD cohort had significantly worse social adaptation (with prolonged unemployment and a paucity of close friendships and love relationships) compared with both their siblings and NCDS controls. Self-reports showed a higher rate of schizotypal features but not affective disorder. Four DLD adults had serious mental health problems (two had developed schizophrenia).<ref>{{cite journal |last1=Clegg |first1=J. |last2=Hollis |first2=C. |last3=Mawhood |first3=L. |last4=Rutter |first4=M. |title=Developmental language disorders - a follow-up in later adult life. Cognitive, language and psychosocial outcomes |journal=Journal of Child Psychology and Psychiatry |date=February 2005 |volume=46 |issue=2 |pages=128–149 |doi=10.1111/j.1469-7610.2004.00342.x }}</ref>
 ==See also==