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Introducing the SLI debate

July 2014
International Journal of Language & Communication Disorders 49(4):377-80

DOI:10.1111/1460-6984.12119

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PubMed

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Authors:

Susan Ebbels

University College London

It is my great pleasure to introduce this special issue on specific language impairment (SLI). The special issue re-examines the diagnostic criteria for SLI and questions whether the term ‘SLI’ should continue be used as a diagnostic label for children with ‘unexplained language problems’ (the term used by Bishop 2014 in her lead article).

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INT J LANG COMMUN DISORD,JULY–AUGUST 2014,

VOL. 49, NO. 4, 377–380

Editorial

Introducing the SLI debate

Susan Ebbels

It is my great pleasure to introduce this special issue

on speciﬁc language impairment (SLI). The special

issue re-examines the diagnostic criteria for SLI and

questions whether the term ‘SLI’ should continue be

used as a diagnostic label for children with ‘unexplained

language problems’ (the term used by Bishop 2014 in

her lead article).

This special issue has come about because of increas-

ing dissatisfaction in many quarters with the wide vari-

ability in the diagnostic criteria used and the labels given

to children with unexplained language problems. This

variability is contributing to a lack of equity of access to

services and limited recognition and understanding of

children’s language problems both by the general pub-

lic and the scientiﬁc community (Bishop 2010). Recent

population studies (e.g., Tomblin et al. 1996, Reilly et al.

2010) allow examination of the validity of the diagnostic

criteria from a new perspective and thus reconsideration

of our use of these criteria is timely. The debate about

labels has been highlighted by the exclusion of SLI in the

recently published Diagnostic and Statistical Manual of

Mental Disorders (DSM-5) (American Psychiatric Asso-

ciation 2013), as recommended by the American Speech

and Hearing Association (ASHA). ‘Language Disorder’

is used instead. The International Classiﬁcation of Dis-

eases and Related Health Problems (ICD-11), currently

in preparation, is also unlikely to use ‘SLI’.

In the UK, a live debate entitled ‘What is Speciﬁc

Language Impairment?’ in May 2012 raised several is-

sues about diagnostic criteria, labels and services. The

main issues regarding diagnosis were: the role of non-

verbal IQ in diagnosis of language problems, differential

diagnosis from autistic spectrum disorder (ASD) and

the label that should be used for children with unex-

plained language difﬁculties. The debate also revealed

that diagnostic labels and criteria were being used cre-

atively in disputes over access to services both by those

seeking to obtain services for children (often parents

and their lawyers) who could be accused of ‘diagnos-

tic shopping’ and also by those seeking to deny services

(often due to ﬁnancial constraints) who may use particu-

larly restrictive criteria in order to reduce the number of

children qualifying for services (see also Wright 2014).

Videos and slides from the debate can been viewed at

http://www.moorhouseschool.co.uk/sli-debate/.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction

in any medium, provided the original work is properly cited.

Following this live debate, discussions with the

Royal College of Speech and Language Thera-

pists (RCSLT) about how to broaden the de-

bate led to development of the SLI webpage

(http://www.rcslt.org/members/clinical_areas/SLI) and

a series of articles in the Bulletin from April to October

2013 (Bishop 2013, Clark et al. 2013, Dockrell 2013,

Ebbels 2013, Lascelles 2013, McCartney 2013, Norbury

2013, Slonims 2013) focusing on diagnosis of SLI, la-

bels used, how to meet language needs in the classrooms

and the parental perspective.

Widening the debate further was still high on the

agenda, thus I was delighted to learn that Sheena Reilly

had been invited to present the IJLCD winter lecture in

December 2013 and she was proposing to talk about

the diagnostic criteria and label of SLI. Meanwhile, the

RALLI (Raising Awareness of Language Learning Im-

pairments) team, who aim to raise public awareness

of children with unexplained language problems (see

http://www.youtube.com/RALLIcampaign), found that

terminology was a major stumbling block. As a result

of lack of progress in this area, Dorothy Bishop sug-

gested to the IJLCD editorial board that a special issue

on SLI with lead articles and commentaries from a range

of perspectives would be a good way to move the de-

bate forward. Thus, the special issue was born, with

two lead articles: one from Bishop entitled ‘Ten ques-

tions about terminology for children with unexplained

language problems’ and one from Reilly and colleagues

based on her winter lecture entitled: ‘Speciﬁc language

impairment: a convenient label for whom?’ Each article

is followed by 10 commentaries from a range of ex-

perts from several different countries commenting from

their various perspectives as academics, speech and lan-

guage therapists, educational psychologists, special ed-

ucational needs lawyers, and representatives of charities

working for and with children with unexplained lan-

guage problems and their parents. The discussion is

then continued in a response article jointly authored

by Reilly, Bishop and Bruce Tomblin entitled: ‘Termi-

nological debate over language impairment in children:

forward movement and sticking points’.

The articles and commentaries raise many important

issues about the diagnosis of children with unexplained

language problems. They discuss identiﬁcation of a

International Journal of Language & Communication Disorders

ISSN 1368-2822 print/ISSN 1460-6984 online

C2014 The Authors International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists

DOI: 10.1111/1460-6984.12119

378 Editorial

language problem and the validity of exclusionary crite-

ria. They argue that the precise criteria used may need

to be different for research versus identiﬁcation of those

who need access to services (Bellair et al. 2014, Reilly

et al. 2014b). Indeed, Rutter (2014) discusses how di-

agnosis of a disorder is not tantamount to a need for

treatment, and Lauchlan and Boyle (2014) state that

there is little evidence that a diagnostic label dictates the

intervention a child should receive.

In terms of diagnostic criteria, even the identiﬁcation

of a language problem is not straightforward. Should

language tests be used and if so, which tests, with which

cut-points? Reilly et al. (2014a) suggest using a cut-

point of –1.25 SD, with children scoring <–1 SD also

being monitored. Several commentators point out prob-

lems with this approach, e.g. many false-positives may

be identiﬁed (Norbury 2014) and standardized tests are

particularly unreliable for identifying bilingual children

(Bellair et al. 2014). There were also concerns that lim-

ited resources would be severely stretched by the identi-

ﬁcation of so many children (Norbury 2014, Parsons et

al. 2014). The addition of functional assessments is ad-

vocated by both lead articles and many commentators,

not only to reduce false-positives, but also to ensure

that children with functional difﬁculties have access to

services (Grist and Hartshorne 2014, Norbury 2014,

Snowling 2014, Whitehouse 2014). In terms of provi-

sion of services, some commentators stress the need to

consider the holistic proﬁle of the child, the range of

needs and how these impact on each other (Bellair et al.

2014, Strudwick and Bauer 2014).

The validity and usefulness of exclusionary criteria

is a major focus of the articles in this special issue.

While both lead articles recognize there may be a

place for exclusionary criteria in some research studies

(although they stress that these ‘pure cases’ will not

then be representative of children in clinical contexts),

they both argue that use of most exclusionary criteria

is probably not justiﬁed for deciding who should

receive intervention. Most commentators agree. Indeed,

Dockrell and Lindsay (2014), see dropping exclusionary

criteria as a positive step towards a common language

between professionals and academics. However, some

commentators recommend that criteria previously used

to exclude a diagnosis of SLI should still be noted,

but should no longer exclude diagnosis (Rutter 2014,

Strudwick and Bauer 2014).

The evidence against using non-verbal IQ is dis-

cussed in some detail. Both lead articles and the com-

mentators agree that requiring a gap between non-verbal

IQ and language abilities (‘cognitive referencing’) should

be dropped, as its use is ‘largely discredited’ (Bishop

2014), ‘conceptually unsound’ (Reilly et al. 2014a) and

‘misinformed’ (Leonard 2014). However, there is dis-

agreement about whether there should be some mini-

mal level of non-verbal ability, and if so, what that level

should be. Hansson et al. (2014) state that a cut-off of

70 is used in most Swedish research on SLI.

In terms of what label to give to children with un-

explained language problems, the articles and commen-

taries are more mixed in their views. However, in their

response article, Reilly et al. (2014b) rule out three po-

tential labels: Language delay because it ‘implies eventual

catch-up in skills, which is not typically what is seen’

and is ‘often used to deny services to children’ (see also

Wright 2014); primary language impairment because it

is difﬁcult to judge which condition is primary in a

child with more than one impairment (Conti-Ramsden

2014) and it could be confused with primary school-age

(Clark and Carter 2014); and language disorder because

it yields too many results unrelated to children’s un-

explained language problems when entered as a search

term (Bishop 2014).

Half of the commentators are in favour of dropping

the term SLI to reﬂect the relaxation of exclusionary

criteria which all agreed is required. But others feel that

changing the label risks breaking the link with past re-

search (Gallagher 2014, Rice 2014, Taylor 2014) and

prefer to keep the term, but revise the meaning of the

term ‘speciﬁc’ to mean ‘idiopathic’ (i.e., ‘of unknown

origin’; Bishop 2014). However, concern is expressed

that keeping the term ‘speciﬁc’ would encourage people

to continue to use inappropriate exclusionary criteria.

Of the remaining possible terms, language learning

impairment was viewed favourably by most, except par-

ents (H¨

uneke and Lascelles 2014). The fewest objections

were raised to developmental language disorder,wheredis-

order is used to refer to conditions without obvious aeti-

ology (Baird 2014), not to whether the child’s language

proﬁle is ‘spikey’ or ‘ﬂat’; a distinction which Reilly

et al. (2014b) say ‘has no validity as an indicator of

either aetiology or prognosis’.

Ultimately, Reilly et al. (2014b) argue in their re-

sponse article that we need a diagnostic label which

works for services, families and individuals. This is an

ambitious goal, but in order to achieve it, the authors

(and several of the commentators) call for an interna-

tional and multidisciplinary panel to be formed that

should aim to build consensus about ﬁrst the diagnos-

tic criteria and second the diagnostic label. This panel

should take account of the views of families and people

with language problems and policy-makers and could

produce a position statement on the issue. In the mean-

time, we would like to solicit the views of readers of this

special issue and encourage you to join in the discussion

via www.rcslt.org/news/news/2014 news archive/ijlcd

discussion forum.

It has been a great pleasure to work with Dorothy

Bishop, Sheena Reilly and Bruce Tomblin while editing

this special issue and also to work with the 32 com-

mentators who between them provided 20 wonderfully

insightful commentaries. I thank them all for meeting

Editorial 379

extremely tight deadlines to enable this project to come

to fruition under a year from its inception.

Associate Editor, IJLCD

References

AMERICAN PSYCHIATRIC ASSOCIATION, 2013, Diagnostic and Statis-

tical Manual of Mental Disorders (DSM-5) (Arlington, VA:

American Psychiatric Association).

BAIRD, G., 2014, Lumping, splitting, drawing lines, statistical cut-

offs and impairment. Commentary on Bishop, D. V. M., Ten

questions about terminology for children with unexplained

language problems. International Journal of Language and

Communication Disorders,49, 381–415. doi: 10.1111/1460-

6984.12101

BELLAIR,J.,CLARK, S. and LYNHAM, S., 2014, Can any label work

for both intervention and research purposes? Commentary

on Bishop, D. V. M., Ten questions about terminology for

children with unexplained language problems. International

Journal of Language and Communication Disorders,49, 381–

415. doi: 10.1111/1460-6984.12101

BISHOP, D. V. M., 2010, Which neurodevelopmental disorders get

researched and why?, PLOS One,5, e15112.

BISHOP, D. V. M., 2013, SLI: the invisible neuro-developmental

disorder. RCSLT Bulletin,April(732), 14.

BISHOP, D. V. M., 2014, Ten questions about terminology for chil-

dren with unexplained language problems. International Jour-

nal of Language and Communication Disorders,49, 381–415.

CLARK, A. and CARTER, G., 2014, What should we call children

with unexplained language difﬁculties? A practical perspec-

tive. Commentary on Bishop, D. V. M., Ten questions about

terminology for children with unexplained language prob-

lems. International Journal of Language and Communication

Disorders,49, 381–415. doi: 10.1111/1460-6984.12101

CLARK,A.,CARTER,G.,CHALMERS,C.,ROSS, E. and SIMPSON,

S, 2013, Tangled terminology: what’s in a name? RCSLT

Bulletin,September(737), 20–21.

CONTI-RAMSDEN, G., 2014, What should we call children who

struggle to talk? Taking a developmental, global perspective

of diagnostic labels—reﬂections on Bishop (2014). Commen-

tary on Bishop, D. V. M., Ten questions on terminology for

children with unexplained language problems. International

Journal of Language and Communication Disorders,49, 381–

415. doi: 10.1111/1460-6984.12101

DOCKRELL, J., 2013, Meeting language needs in classrooms. RCSLT

Bulletin,August(736), 20–21.

DOCKRELL, J. and LINDSAY, G., 2014, The view from the chalk face.

Commentary on Reilly, S., Tomblin, B., Law, J., McKean, C.,

Mensah, F. K., Morgan, A., Goldfeld, S., Nicholson, J. M.

and Wake, M., 2014, Speciﬁc language impairment: a conve-

nient label for whom? International Journal of Language and

Communication Disorders,49, 416–451. doi: 10.1111/1460-

6984.12102

EBBELS, S. H., 2013, Guest Editorial: Introducing the Bulletin SLI

series. RCSLT Bulletin,April(732), 3.

GALLAGHER, A., 2014, What’s in a name? Some thoughts on Reilly

et al. (2014). Commentary on Reilly, S., Tomblin, B., Law,

J., McKean, C., Mensah, F. K., Morgan, A., Goldfeld, S.,

Nicholson, J. M. and Wake, M., 2014, Speciﬁc language im-

pairment: a convenient label for whom? International Journal

of Language and Communication Disorders,49, 416–451. doi:

10.1111/1460-6984.12102

GRIST,M.andHARTSHORNE, V. M., 2014, Please! No more spaghetti

....CommentaryonReilly,S.,Tomblin, B., Law, J., McK-

ean, C., Mensah, F. K., Morgan, A., Goldfeld, S., Nichol-

son, J. M. and Wake, M., 2014, Speciﬁc language impair-

ment: a convenient label for whom? International Journal of

Language and Communication Disorders,49, 416–451. doi:

10.1111/1460-6984.12102

HANSSON,K.,SANDGREN, O. and SAHLEN, B., 2014, Changing

labels for a concept in change. Commentary on Bishop,

D. V. M., Ten questions about terminology for children

with unexplained language problems. International Journal

of Language and Communication Disorders,49, 381–415. doi:

10.1111/1460-6984.12101

H¨

UNEKE, A. and LASCELLES, L., 2014, Terminology mayhem: why it

matters—the ramiﬁcation for parents and families. Commen-

tary on Bishop, D. V. M., Ten questions about terminology

for children with unexplained language problems. Interna-

tional Journal of Language and Communication Disorders,49,

381–415. doi: 10.1111/1460-6984.12101

LASCELLES, L., 2013, The parental perspective. RCSLT Bulletin,

October(738), 19.

LAUCHLAN,F.andBOYLE, C., 2014, To label or not to label: Isthis the

question? Commentary on Bishop, D. V. M., Ten questions

about terminology for children with unexplained language

problems. International Journal of Language and Communica-

tion Disorders,49, 381–415. doi: 10.1111/1460-6984.12101

LEONARD, L., 2014, Replacing one imperfect term with another.

Commentary on Reilly, S., Tomblin, B., Law, J., McKean,

C., Mensah, F. K., Morgan, A., Goldfeld, S., Nicholson, J.

M. and Wake, M., 2014, Speciﬁc language impairment: a con-

venient label for whom? International Journal of Language and

Communication Disorders,49, 416–451. doi: 10.1111/1460-

6984.12102

MCCARTNEY, E., 2013, Speciﬁc language impairment in schools.

RCSLT Bulletin,June(734), 20–21.

NORBURY, C. F., 2013, Where are the boundaries? RCSLT Bulletin,

April(732), 12–13.

NORBURY, C. F., 2014, Language Impairment: where do we draw the

line? Commentary on Reilly, S., Tomblin, B., Law, J., McK-

ean, C., Mensah, F. K., Morgan, A., Goldfeld, S., Nichol-

son, J. M. and Wake, M., 2014, Speciﬁc language impair-

ment: a convenient label for whom? International Journal of

Language and Communication Disorders,49, 416–451. doi:

10.1111/1460-6984.12102

PARSONS,S.,JORDAN, E. and BRANAGAN, A., 2014, Changes to

speciﬁc language impairment: the service perspective. Com-

mentary on Reilly, S., Tomblin, B., Law, J., McKean, C.,

Mensah, F. K., Morgan, A., Goldfeld, S., Nicholson, J. M.

and Wake, M., 2014, Speciﬁc language impairment: a conve-

nient label for whom? International Journal of Language and

Communication Disorders,49, 416–451. doi: 10.1111/1460-

6984.12102

REILLY,S.,BISHOP,D.V.MandTOMBLIN, B., 2014b, Termino-

logical debate over language impairment in children: for-

ward movement and sticking points. International Journal of

Language and Communication Disorders,49, 452–562. doi:

10.1111/1460-6984.12111

REILLY,S.,TOMBLIN,B.,LAW ,J.,MCKEAN,C.,MENSAH,F.,MOR-

GAN,A.,GOLDFELD,S.,NICHOLSON, J. and WAKE,M.,

2014a, SLI: a convenient label for whom? International Jour-

nal of Language and Communication Disorders,49, 416–451.

doi: 10.1111/1460-6984.12102

REILLY,S.,WAKE,M.,UKOUMUNNE,C.O.,BAV IN,E.,PRIOR,M.,

CINI,E.,CONWAY,L.,EADIE, P. and BRETHERTON, L., 2010,

Predicting language outcomes at 4 years of age: ﬁndings from

Early Language in Victoria Study. Pediatrics,126(6), e1530–

e1537.

RICE, M. L, 2014, Advocating for SLI. Commentary on Bishop,

D. V. M., Ten questions about terminology for children

380 Editorial

with unexplained language problems. International Journal

of Language and Communication Disorders,49, 381-415. doi:

10.1111/1460-6984.12101

RUTTER, M., 2014, Classiﬁcation purposes and diagnostic concepts.

Commentary on Reilly, S., Tomblin, B., Law, J., McKean, C.,

Mensah, F. K., Morgan, A., Goldfeld, S., Nicholson, J. M.

and Wake, M., 2014, Speciﬁc language impairment: a conve-

nient label for whom? International Journal of Language and

Communication Disorders,49, 416-451. doi: 10.1111/1460-

6984.12102

SLONIMS, V., 2013, A test for the profession. RCSLT Bulletin,

June(734), 22.

SNOWLING, M. J., 2014, SLI—not just a semantic issue. Commen-

tary on Reilly, S., Tomblin, B., Law, J., McKean, C., Mensah,

F. K., Morgan, A., Goldfeld, S., Nicholson, J. M. and Wake,

M., 2014, Speciﬁc language impairment: a convenient label

for whom? International Journal of Language and Communica-

tion Disorders,49, 416–451. doi: 10.1111/1460-6984.12102

STRUDWICK, M. and BAUER, A., 2014, Getting behind the la-

bel: practitioners’ point of view. Commentary on Bishop,

D. V. M., Ten questions about terminology for children

with unexplained language problems. International Journal

of Language and Communication Disorders,49, 381–415. doi:

10.1111/1460-6984.12101

TAYLOR , C. L., 2014, The SLI construct is a critical link to the

past and a bridge to the future. Commentary on Bishop,

D. V. M., Ten questions about terminology for children

with unexplained language problems. International Journal

of Language and Communication Disorders, 49, 381–415. doi:

10.1111/1460-6984.12101

TOMBLIN,J.B.,RECORDS, N. and ZHANG, X., 1996, A system for

the diagnosis of speciﬁc language impairment in kindergarten

children. Journal of Speech and Hearing Research,39(6), 1284–

1294.

WHITEHOUSE, A. J. O., 2014, Reﬁning language impairment: re-

searchers must pay their part too. Commentary on Reilly, S.,

Tomblin,B.,Law,J.,McKean,C.,Mensah,F.K.,Morgan,A.,

Goldfeld, S., Nicholson, J. M. and Wake, M., 2014, Speciﬁc

language impairment: a convenient label for whom? Interna-

tional Journal of Language and Communication Disorders,49,

416–451. doi: 10.1111/1460-6984.12102

WRIGHT, E., 2014, Special educational needs provision in the real

world. Commentary on Reilly, S., Tomblin, B., Law, J., McK-

ean, C., Mensah, F. K., Morgan, A., Goldfeld, S., Nichol-

son, J. M. and Wake, M., 2014, Speciﬁc language impair-

ment: a convenient label for whom? International Journal of

Language and Communication Disorders,49, 416–451. doi:

10.1111/1460-6984.12102

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Apr 2023
INT J LANG COMM DIS

Background: In 2016/17, the CATALISE Consortium published the results of a multinational and multidisciplinary Delphi consensus study, representing agreement among professionals about the definition and process of identification of children with Developmental Language Disorder (DLD) (Bishop et al., 2016, 2017). The extent to which the current clinical practice of UK speech and language therapists (SLTs) reflects the CATALISE consensus statements is unknown. Aims: To investigate how UK SLTs' expressive language assessment practices reflect the CATALISE documents' emphasis on the functional impairment and impact caused by DLD, by examining: whether multiple sources of assessment information are gathered; how standardised and non-standardised sources are combined in clinical decision-making, and how clinical observation and language sample analysis are utilised. Methods and procedures: An anonymous, online survey was carried out between August 2019 and January 2020. It was open to UK-based paediatric SLTs who assess children up to age 12 with unexplained difficulties using language. Questions probed different aspects of expressive language assessment which are referred to in the CATALISE consensus statements and supplementary comments, and asked about participants' familiarity with the CATALISE statements. Responses were analysed using simple descriptive statistics and content analysis. Outcomes and results: The questionnaire was completed by 104 participants, from all four regions of the United Kingdom, working in a range of clinical settings with different levels of professional experience of DLD. The findings indicate that clinical assessment practices broadly align with the CATALISE statements. Although clinicians carry out standardised assessments more frequently than other types of assessment, they also gather information from other sources and use this alongside standardised test scores to inform clinical decisions. Clinical observation and language sample analysis are commonly utilised to evaluate functional impairment and impact, along with parent/carer/teacher and child report. However, asking about the child's own perspective could be more widely utilised. The findings also highlight a lack of familiarity with the details of the CATALISE documents among two thirds of the participants. Conclusions and implications: Assessment practices broadly align with the CATALISE statements, but there is a need for greater clarity regarding terminology and the assessment of functional language impairment and impact. This research should prompt discussion in the profession about how to further develop and adopt expressive language assessment practices which reflect the CATALISE consensus and support effective assessment. What this paper adds: What is already known on the subject The CATALISE consortium documents on Developmental Language Disorder (DLD) were published in 2016/17. The extent to which expressive language assessment practice in the United Kingdom reflects the new definition and statements on assessment has not previously been investigated. What this paper adds to existing knowledge This survey indicates that speech and language therapists in the United Kingdom assessing children for DLD mostly balance standardised language test scores with other sources of information in clinical decision-making, and utilise clinical observation and language sample analysis to consider functional impairment and the impact of the language disorder. However, important questions are raised regarding the robustness and objectivity with which these key parameters are currently defined and evaluated. What are the potential or actual clinical implications of this work? Clinicians, individually and at service level, are encouraged to reflect on their assessment of functional impairment and the impact of language disorder and to take steps to incorporate this where necessary. Professional guidance and clinical tools to facilitate robust, objective assessment would support clinical practice that aligns with expert consensus.

The production of passives in Mandarin children with and without developmental language disorder

Article

Dec 2024
First Lang

We used the elicited production task to explore the production of short and long passives in 15 Mandarin-speaking preschool children with Developmental Language Disorder (DLD; aged 4;2–5;11) in comparison with 15 Typically Developing Aged-matched (TDA) children (aged 4;3–5;8) and 15 Typically Developing Younger (TDY) children (aged 3;2–4;3). This particular task resulted in a preference for long passives over short passives by Mandarin-speaking children. However, children with DLD exhibited lower proficiency in the production of passives than TDA and TDY children. Moreover, this group was prone to produce avoidance strategies as alternatives to constructing long passives, such as passives without the intervention effect (exemplified by long passives with an implicit subject), non-target passives (such as short passives without a marker and long passives with a resumptive pronoun or noun), and a range of other responses (including active constructions, irrelevant responses, and cases of non-production). In line with the Edge Feature Underspecification Hypothesis, challenges encountered by children with DLD in producing long passives can be attributed to the Relativized Minimality effect. The observed reliance on avoidance strategies in the passive production task reflected their compromised syntactic knowledge. We conclude that the central syntactic deficit in children with DLD appears to lie in structure building.

Gelişimsel Dil Bozukluğu Olan Vakaların Klinik Yönetimi: Nitel Bir Çalışma

Article

Dec 2023

Diagnostic procedures of paediatric speech and language therapists in the UK: Enabling and obstructive factors

Article

Mar 2023
INT J LANG COMM DIS

Hannah Harvey

Background: Extensive variation in the terminology used for paediatric diagnoses across the speech and language therapy research literature is an internationally recognized problem. Little is known, however, about how and how often diagnoses are given in a clinical context. In the UK, speech and language therapists (SLTs) identify and support children who have speech and language needs. To understand and address clinically rooted terminological issues that may directly impact clients and families, there is a need for exploration of how the diagnostic process is operationalized in practice. Aim: To identify, from the perspective of SLTs, areas that present as enabling and obstructive factors to conducting diagnosis in clinical practice. Methods & procedures: Taking a phenomenological approach, 22 paediatric SLTs were interviewed using a semi-structured format. Thematic analysis revealed a number of factors that were either classified as 'enabling' or 'obstructive' to their diagnostic processes. Outcomes & results: Participants were often hesitant to provide a diagnosis to families and universally reported the need for targeted guidance, which accounts for the demands of current clinical practice, to guide their diagnostic process. Four enabling factors were identified from participant data: (1) working to a medical model, (2) the availability of collegiate support, (3) recognizing the benefits of diagnosis,, and (4) relating to the needs of the family. Seven themes portrayed obstructive factors in practice: (1) the complex presentation of clients, (2) the risk of giving a 'wrong' diagnosis, (3) participants' uncertainty about diagnostic criteria, (4) insufficient training, (5) service models, (6) concerns about stigma and (7) not having enough clinical time. The obstructive factors created dilemmas for participants and resulted in hesitancy to give a diagnosis, potentially contributing to delays in diagnosis experienced by families as reported in previous literature. Conclusions & implications: Of paramountcy to SLTs were the individual needs and preferences of their clients. Practical barriers and areas of uncertainty increased hesitance to diagnose, which may inadvertently preclude families from accessing resources. Recommendations include more widely accessible training in diagnostic practice, guidelines to support clinical decision-making, and a greater understanding of client preferences with regard to terminology and its potential relationship with social stigma. What this paper adds: What is already known on the subject Inconsistency in terminology for paediatric language diagnoses has been broadly discussed, mostly in reference to variation within research literature. The Royal College of Speech and Language Therapists' (RCSLT) position statement on developmental language disorder (DLD) and language disorder made recommendations for SLTs to use these terms in clinical practice. There is some evidence that SLTs face challenges in operationalizing diagnostic criteria in practice, particularly given financial and resource constraints. What this paper adds to existing knowledge SLTs disclosed several issues that either supported or were obstructive to the practice of diagnosing paediatric clients and delivering this information to families. Whilst most SLTs faced constraints related to the practicalities and demands of clinical practice, a number also held reservations about the impact of a lifelong diagnosis for young clients. These issues resulted in considerable avoidance of formal diagnostic terminology, in favour of description or informal terminology. What are the potential or actual clinical implications of this work? If diagnoses are not given, or if SLTs are using informal diagnostic terms as an alternative strategy, clients and families may experience reduced opportunities to yield benefits associated with a diagnosis. Clinical guidance that specifically addresses the prioritization of time and provides directives for clinical action in instances of uncertainty may support SLTs to feel confident in giving diagnoses.

SLI czy DLD? Zmiany w terminologii zaburzeń mowy o niejednoznacznej etiologii w kontekście polskiego prawa oświatowego

Article

Full-text available

Dec 2022

Ewa Gacka

Artykuł poświęcono zaburzeniom mowy o niejasnej/niejednoznacznej przyczynie. W literaturze przedmiotu funkcjonuje wiele określeń tego typu zaburzeń komunikacji językowej. Jednym z nich jest SLI (specyficzne zaburzenie rozwoju językowego). Zgodnie z ustaleniami międzynarodowych ekspertów zaleca się odejście od terminu SLI na rzecz DLD (rozwojowe zaburzenie językowe/języka). W artykule zaprezentowano przesłanki leżące u podstaw takiego rozwiązania. Jednocześnie omówiono konsekwencje braku w polskim prawie oświatowym terminów określających zaburzenia mowy występujące bez wyraźnej przyczyny.

Aquisição e desenvolvimento atípico da linguagem em crianças surdas

Chapter

Full-text available

Nov 2022

O presente capítulo aborda os efeitos da surdez na aquisição e desenvolvimento da linguagem na modalidade linguística gestual e oral. Começando por uma breve descrição dos diferentes graus, tipos e causas que caracterizam a surdez, e que devem ser considerados aquando da observação do desempenho linguístico de uma criança surda, o capítulo explora vários indicadores de um desenvolvimento atípico na aquisição de uma língua gestual e, particularmente, da Língua Gestual Portuguesa, em diferentes áreas do conhecimento linguístico (fonologia, morfologia, sintaxe e semântica). Adicionalmente, com base nos primeiros estudos de linguagem realizados a crianças portuguesas surdas com implante(s) cocleare(s), descreve-se o desenvolvimento atípico na aquisição de uma língua oral (particularmente, do Português Europeu), revelando, em específico, as dificuldades identificadas em tarefas de produção de conhecimento fonológico e em tarefas de compreensão e produção de conhecimento sintático. Em jeito de conclusão, são colocadas questões associadas aos instrumentos de avaliação e de diagnóstico de conhecimento linguístico utilizados em crianças surdas.

Terminological debate over language impairment in children: Forward movement and sticking points

Article

Full-text available

Jul 2014
INT J LANG COMM DIS

Background There is no agreed terminology for describing childhood language problems. In this special issue Reilly et al. and Bishop review the history of the most widely used label, ‘specific language impairment’ (SLI), and discuss the pros and cons of various terms. Commentators from a range of backgrounds, in terms of both discipline and geographical background, were then invited to respond to each lead article. Aims To summarize the main points made by the commentators and identify (1) points of consensus and disagreement, (2) issues for debate including the drivers for change and diagnostic criteria, and (3) the way forward. Conclusions & Implications There was some common ground, namely that the current situation is not tenable because it impedes clinical and research progress and impacts on access to services. There were also wide-ranging disagreements about which term should be adopted. However, before debating the broad diagnostic label it is essential to consider the diagnostic criteria and the systems used to classify childhood language problems. This is critical in order to facilitate communication between and among clinicians and researchers, across sectors (in particular health and education), with the media and policy-makers and with families and individuals who have language problems. We suggest four criteria be taken into account when establishing diagnostic criteria, including: (1) the features of language, (2) the impact on functioning and participation, (3) the presence/absence of other impairments, and (4) the language trajectory or pathway and age of onset. In future, these criteria may expand to include the genetic and neural markers for language problems. Finally, there was overarching agreement about the need for an international and multidisciplinary forum to move this debate forward. The purpose would be to develop consensus regarding the diagnostic criteria and diagnostic label for children with language problems. This process should include canvassing the views of families and people with language problems as well as the views of policy-makers.

Specific language impairment: A convenient label for whom?: SLI: A convenient label for whom?

Article

Full-text available

Jul 2014
INT J LANG COMM DIS

Background: The term 'specific language impairment' (SLI), in use since the 1980s, describes children with language impairment whose cognitive skills are within normal limits where there is no identifiable reason for the language impairment. SLI is determined by applying exclusionary criteria, so that it is defined by what it is not rather than by what it is. The recent decision to not include SLI in DSM-5 provoked much debate and concern from researchers and clinicians. Aims: To explore how the term 'specific language impairment' emerged, to consider how disorders, including SLI, are generally defined and to explore how societal changes might impact on use the term. Methods & procedures: We reviewed the literature to explore the origins of the term 'specific language impairment' and present published evidence, as well as new analyses of population data, to explore the validity of continuing to use the term. Outcomes & results and conclusions & implications: We support the decision to exclude the term 'specific language impairment' from DSM-5 and conclude that the term has been a convenient label for researchers, but that the current classification is unacceptably arbitrary. Furthermore, we argue there is no empirical evidence to support the continued use of the term SLI and limited evidence that it has provided any real benefits for children and their families. In fact, the term may be disadvantageous to some due to the use of exclusionary criteria to determine eligibility for and access to speech pathology services. We propose the following recommendations. First, that the word 'specific' be removed and the label 'language impairment' be used. Second, that the exclusionary criteria be relaxed and in their place inclusionary criteria be adopted that take into account the fluid nature of language development particularly in the preschool period. Building on the goodwill and collaborations between the clinical and research communities we propose the establishment of an international consensus panel to develop an agreed definition and set of criteria for language impairment. Given the rich data now available in population studies it is possible to test the validity of these definitions and criteria. Consultation with service users and policy-makers should be incorporated into the decision-making process.

Ten questions about terminology for children with unexplained language problems

Article

Full-text available

Jul 2014
INT J LANG COMM DIS

Dorothy Vera Margaret Bishop

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

Which Neurodevelopmental Disorders Get Researched and Why?

Article

Full-text available

Nov 2010
PLOS ONE

Dorothy Vera Margaret Bishop

There are substantial differences in the amount of research concerned with different disorders. This paper considers why. Bibliographic searches were conducted to identify publications (1985-2009) concerned with 35 neurodevelopmental disorders: Developmental dyslexia, Developmental dyscalculia, Developmental coordination disorder, Speech sound disorder, Specific language impairment, Attention deficit hyperactivity disorder, Autistic spectrum disorder, Tourette syndrome, Intellectual disability, Angelman syndrome, Cerebral palsy, Cornelia de Lange syndrome, Cri du chat syndrome, Down syndrome, Duchenne muscular dystrophy, Fetal alcohol syndrome, Fragile X syndrome, Galactosaemia, Klinefelter syndrome, Lesch-Nyhan syndrome, Lowe syndrome, Marfan syndrome, Neurofibromatosis type 1, Noonan syndrome, Phenylketonuria, Prader-Willi syndrome, Rett syndrome, Rubinstein-Taybi syndrome, Trisomy 18, Tuberous sclerosis, Turner syndrome, Velocardiofacial syndrome, Williams syndrome, XXX and XYY. A publication index reflecting N publications relative to prevalence was derived. The publication index was higher for rare than common conditions. However, this was partly explained by the tendency for rare disorders to be more severe. Although research activity is predictable from severity and prevalence, there are exceptions. Low rates of research, and relatively low levels of NIH funding, characterise conditions that are the domain of a single discipline with limited research resources. Growth in research is not explained by severity, and was exceptionally steep for autism and ADHD.

Predicting Language Outcomes at 4 Years of Age: Findings From Early Language in Victoria Study

Article

Full-text available

Nov 2010
Pediatrics

To quantify the contributions of child, family, and environmental predictors to language ability at 4 years. A longitudinal study was performed with a sample of 1910 infants recruited at 8 months in Melbourne, Australia. Predictors were child gender, prematurity, birth weight and order, multiple birth, socioeconomic status, maternal mental health, vocabulary, education, and age at child's birth, non-English-speaking background, and family history of speech/language difficulties. Outcomes were Clinical Evaluation of Language Fundamentals-Preschool, language scores, low language status (scores >1.25 SDs below the mean), and specific language impairment (SLI) (scores >1.25 SDs below the mean for children with normal nonverbal performance). A total of 1596 children provided outcome data. Twelve baseline predictors explained 18.9% and 20.9% of the variation in receptive and expressive scores, respectively, increasing to 23.6% and 30.4% with the addition of late talking status at age 2. A total of 20.6% of children (324 of 1573 children) met the criteria for low language status and 17.2% (251 of 1462 children) for SLI. Family history of speech/language problems and low maternal education levels and socioeconomic status predicted adverse language outcomes. The combined predictors discriminated only moderately between children with and without low language levels or SLIs (area under the curve: 0.72-0.76); this improved with the addition of late talking status (area under the curve: 0.78-0.84). Measures of social disadvantage helped explain more variation in outcomes at 4 years than at 2 years, but ability to predict low language status and SLI status remained limited.

A System for the Diagnosis of Specific Language Impairment in Kindergarten Children

Article

Full-text available

Dec 1996
J SPEECH LANG HEAR R

A valid and reliable diagnostic standard for language impairment is required for the conduct of epidemiologic research on specific language disorder. A rationale is provided for such a diagnostic system labeled the EpiSLI system. This system employed five composite scores representing norm-referenced performance in three domains of language (vocabulary, grammar, and narration) and two modalities (comprehension and production). Children who have two or more composite scores below –1.25 standard deviations were considered as children with language disorder. The performance of the EpiSLI diagnostic system was examined on a sample of 1,502 kindergarten children and it was shown that this diagnostic system yielded results that were consistent with clinician rating and previous research results.

Specific language impairment

Article

Nov 2008

Specific language impairment (SLI) is a developmental disorder without a known cause characterised by various profiles of language difficulties and by different levels of difficulty. This research focuses on connectives in spontaneous language samples of children with SLI. The differences between the group of children with SLI and the group with regular language development was also determined. Finally, the differences between the groups by taking the age factor into account were analyzed. The sample were 71 children with SLI and 71 children with regular language development. All the pupils were from the first to the fourth grade of primary school. The variables are defined by the number and types of connectives. The results showed that the age factor has a lessening impact on connectives between the children with SLI and those with regular language development. The results indicate that the groups were qualitatively different on the variable connectives.

Diagnostic and Statistical Manual of Mental Disorders: DSM-V

Book

Jan 1994

APA American Psychiatric Association

Diagnostic and Statis-tical Manual of Mental Disorders (DSM-5)

Jan 2013

American Psychiatric
Association

References AMERICAN PSYCHIATRIC ASSOCIATION, 2013, Diagnostic and Statis-tical Manual of Mental Disorders (DSM-5) (Arlington, VA: American Psychiatric Association).

What should we call children with unexplained language difficulties? A practical perspec-tive Ten questions about terminology for children with unexplained language prob-lems Tangled terminology: what's in a name

Oct 2015
381-415

G D V M Clark
A Carter
G Chalmers
C Ross
E Simpson

CLARK, A. and CARTER, G., 2014, What should we call children with unexplained language difficulties? A practical perspec-tive. Commentary on Bishop, D. V. M., Ten questions about terminology for children with unexplained language prob-lems. International Journal of Language and Communication Disorders, 49, 381–415. doi: 10.1111/1460-6984.12101 CLARK, A., CARTER, G., CHALMERS, C., ROSS, E. and SIMPSON, S, 2013, Tangled terminology: what's in a name? RCSLT Bulletin, September(737), 20–21.

Introducing the SLI debate

Abstract

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Special issue: Children with specific language impairment across languages - Introduction