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Terminologie der Sprachentwicklungsstörung (SES) Auf dem Weg zu einem internationalen Konsens
Abstract
ZUSAMMENFASSUNG. Der vorliegende Beitrag soll LogopädInnen (klin. SprachtherapeutInnen sind in der Folge eingeschlossen) sowie an logopädischen Maßnahmen beteiligte Berufsgruppen unterstützen, sich über aktuelle internationale Entwicklungen zur Terminologie der Sprachentwicklungsstörung und damit verbundenen veränderten diagnostischen Kriterien zu informieren. Das derzeitige deutsche Klassifikationssystem zur Diagnostik von Sprachentwicklungsstörungen erscheint nicht hinreichend geeignet, da die Störungsformen und Kriterien nicht angemessen formuliert sind.
... Solche Schwierigkeiten können sich nachhaltig negativ auf die soziale, emotionale und schulische Entwicklung eines Kindes auswirken (Conti-Ramsden et al., 2009), sodass diese frühzeitig erkannt und behandelt werden sollten. Seit Veröffentlichung der Empfehlungen des CATALISE-Konsortiums (Bishop et al., 2017(Bishop et al., , 2016 wird die aktuelle Anwendung von diagnostischen Kriterien und Terminologien auch in anderen Ländern diskutiert (Neumann et al., 2021;Breault et al., 2019;Scharff Rethfeldt & Ebbels, 2019;Ahlfont & Nilsson, 2017). Ziel ist die Überprüfung eines Anpassungsbedarfs der Terminologie zur Verbesserung der interprofessionellen Zusammenarbeit, um betroffenen Kindern eine verbesserte Teilhabe und ein verbessertes Wohlbefinden (WHO, 2011) sowie Chancengleichheit in der Schule (UNESCO, 1994) zu ermöglichen. ...
... Vor diesem Hintergrund wurde die Notwendigkeit einer Erhebung der aktuell im deutschsprachigen Raum verwendeten Terminologie und Kriterien von Sprachstörungen im Kindesalter diskutiert und unterstützt (Neumann et al., 2021;Blechschmidt et al., 2019;dbl, 2019;dbs, 2019;Dohmen, 2019;GISKID, 2019;logopädieaustria, 2019;Scharff Rethfeldt & Ebbels, 2019). Schliesslich wurde für diese eine Delphi-Studie durchgeführt und ausgewertet, die massgeblich von einem Verein, der Gesellschaft für interdisziplinäre Spracherwerbsforschung und kindliche Sprachstörungen im deutschsprachigen Raum (GISKID e. V.), finanziert wurde (vgl. ...
Studies have for years emphasized the importance of interprofessional collaboration to improve services for children with speech, language and communication needs while pointing to persistent challenges associated with a notable lack of shared language and inconsistent understanding of terms. The CATALISE (Criteria and Terminology Applied to Language Impairments: Synthesizing the Evidence) Consortium’s recommendations, an outcome of a consensus-building exercise aiming at identification criteria (Bishop et al., 2016) and terminology (Bishop et al., 2017) to be used to refer to language disorders in children, offered an opportunity for revision of terms currently used in the German-speaking area. Findings represent the Swiss data-set (n=58) extrapolated from a survey conducted in 2019 to 2022 by means of a similar Delphi-method encompassing three rounds to seek agreement among diverse professionals (N=435, first round) from Germany, Austria, and the German-speaking part of Switzerland. Results will be compared and discussed for German-speaking Switzerland, with the overall findings and with reference to the international CATALISE recommendations.
In summary, the results for German-speaking Switzerland compared to those from Germany show some similarities (consensus in many aspects) but also some differences, such as a different terminological understanding and preference for using language delay over late talker in Switzerland.
Furthermore, there are more overlaps for German-speaking Switzerland than for Germany with the international recommendations of the CATALISE consortium, which have also been adopted for French-speaking Switzerland.
A uniform use of terminology would be desirable, as suggested by the experts surveyed in Switzerland.
Die interprofessionelle Zusammenarbeit zur Verbesserung der Versorgung von Kindern mit Sprech-, Sprach-und Kommunikationsstörungen hat hohe Relevanz. Entsprechend wichtig ist ein einheitliches Begriffsverständnis. Für den englischsprachigen Raum hat das CATALISE-Konsortium (Criteria and Terminology Applied to Language Impairments: Synthesizing the Evidence, Bishop et al. 2016, 2017) als Ergebnis einer Delphi-Studie neben einer interprofessionell konsentierten Terminologie auch diagnostische Kriterien vorgelegt, die eine Überprüfung in anderen Sprachräumen motivierte. Ausgehend von den CATALISE-Empfehlungen wurde im deutschsprachigen Raum (D-A-CH-Konsortium SES) von 2019 bis 2022 eine ähnliche Delphi-Studie mit drei Befragungsrunden durchgeführt. Der vorliegende Artikel berichtet über die Einschätzungen von Expertinnen und Experten aus der Deutschschweiz (n=58) im Vergleich zu jenen der Teilnehmenden des gesamtdeutschen Sprachraums (anfäng-lich N=435). Eine Einordnung mit Blick auf den bei CATALISE erzielten Konsens wird vorgenommen.
Das "D-A-CH-Konsortium SES“, eine multidisziplinär und multinational zusammengesetzte Steuerungsgruppe, stellt die Ergebnisse einer groß angelegten Delphi-Befragungsstudie zur Definition und Terminologie von Sprachentwicklungsstörungen im deutschsprachigen Raum dar. Die konsentierten Ergebnisse sollen zukünftig zu einer besseren Verständigung über Sprachentwicklungsstörungen beitragen. Der Artikel ist zugänglich unter https://www.prolog-shop.de/media/pdf/fb/89/a2/ORG-Delphi_online1.pdf
A recent project entitled CATALISE used the Delphi method to reach a consensus on terminology for unexplained language problems in children. 'Developmental language disorder' (DLD) was the term agreed by a panel of 57 experts. Here I reflect on points of difficulty that arose when attempting to reach a consensus, using qualitative information from comments made by panel members to illustrate the kinds of argument used. One issue of debate was the use of labels, in particular the term 'disorder', which was seen as having both pros and cons. The potential for labels to stigmatize or create low expectations was a particular concern. However, labels could also ensure language problems were not trivialized and could help avoid stigma by providing an explanation for behaviours that might otherwise meet with disapproval. Further debate surrounded issues of how best to identify cases of disorder. Although it was agreed there should be a focus on cases with a poor prognosis, it was recognized that our knowledge of factors related to prognosis was still incomplete. Furthermore, there was a tension between use of standardized tests, which allow for a relatively objective and reliable assessment of language, and more qualitative observations, which can capture functional aspects of communication that are not always picked up on formal assessment. Debate also surrounded the issue of the relationship between DLD and other conditions. Some favoured drawing a distinction between DLD and language disorders associated with other conditions, and others regarded such distinctions as unnecessary. We concluded that it was misleading to assume co-occurring conditions were causes of language disorder, but it was helpful to distinguish DLD from cases of language disorder associated with 'differentiating conditions' that had a known or likely biomedical origin, including brain injury, sensorineural hearing loss, genetic syndromes, intellectual disability and autism spectrum disorder. Furthermore, DLD could co-occur with milder neurodevelopmental disorders that did not have a clear biomedical aetiology. Normal-range non-verbal IQ has traditionally been incorporated in the diagnosis of DLD, but this was rejected as unsupported by evidence. DLD is a category that has utility in identifying children who would benefit from speech-language therapy services, but it should not be thought of as a well-defined condition. DLD has a multifactorial aetiology, is heterogeneous in terms of language features and overlaps with other neurodevelopmental disorders. Our notions of DLD are likely to be refined by further research into aetiology, associated characteristics and intervention effectiveness.
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.
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).
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.
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’.
Background
This study considers the role of early speech difficulties in literacy development, in the context of additional risk factors.
Method
Children were identified with speech sound disorder (SSD) at the age of 3½ years, on the basis of performance on the Diagnostic Evaluation of Articulation and Phonology. Their literacy skills were assessed at the start of formal reading instruction (age 5½), using measures of phoneme awareness, word‐level reading and spelling; and 3 years later (age 8), using measures of word‐level reading, spelling and reading comprehension.
Results
The presence of early SSD conferred a small but significant risk of poor phonemic skills and spelling at the age of 5½ and of poor word reading at the age of 8. Furthermore, within the group with SSD, the persistence of speech difficulties to the point of school entry was associated with poorer emergent literacy skills, and children with ‘disordered’ speech errors had poorer word reading skills than children whose speech errors indicated ‘delay’. In contrast, the initial severity of SSD was not a significant predictor of reading development. Beyond the domain of speech, the presence of a co‐occurring language impairment was strongly predictive of literacy skills and having a family risk of dyslexia predicted additional variance in literacy at both time‐points.
Conclusions
Early SSD alone has only modest effects on literacy development but when additional risk factors are present, these can have serious negative consequences, consistent with the view that multiple risks accumulate to predict reading disorders.
Background:
Diagnosis of 'specific' language impairment traditionally required nonverbal IQ to be within normal limits, often resulting in restricted access to clinical services for children with lower NVIQ. Changes to DSM-5 criteria for language disorder removed this NVIQ requirement. This study sought to delineate the impact of varying NVIQ criteria on prevalence, clinical presentation and functional impact of language disorder in the first UK population study of language impairment at school entry.
Methods:
A population-based survey design with sample weighting procedures was used to estimate population prevalence. We surveyed state-maintained reception classrooms (n = 161 or 61% of eligible schools) in Surrey, England. From a total population of 12,398 children (ages 4-5 years), 7,267 (59%) were screened. A stratified subsample (n = 529) received comprehensive assessment of language, NVIQ, social, emotional and behavioural problems, and academic attainment.
Results:
The total population prevalence estimate of language disorder was 9.92% (95% CI 7.38, 13.20). The prevalence of language disorder of unknown origin was estimated to be 7.58% (95% CI 5.33, 10.66), while the prevalence of language impairment associated with intellectual disability and/or existing medical diagnosis was 2.34% (95% CI 1.40, 3.91). Children with language disorder displayed elevated symptoms of social, emotional and behavioural problems relative to peers, F(1, 466) = 7.88, p = .05, and 88% did not make expected academic progress. There were no differences between those with average and low-average NVIQ scores in severity of language deficit, social, emotional and behavioural problems, or educational attainment. In contrast, children with language impairments associated with known medical diagnosis and/or intellectual disability displayed more severe deficits on multiple measures.
Conclusions:
At school entry, approximately two children in every class of 30 pupils will experience language disorder severe enough to hinder academic progress. Access to specialist clinical services should not depend on NVIQ.
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.
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Wiebke Scharff Rethfeldt Hochschule Bremen Fakultät 3 -Gesellschaftswissenschaften Angewandte Therapiewissenschaften -Logopädie Neustadtswall 30 28199 Bremen w.scharff.rethfeldt@hs-bremen
- Korrespondenzanschrift Prof
- Dr
Korrespondenzanschrift
Prof. Dr. Wiebke Scharff Rethfeldt
Hochschule Bremen
Fakultät 3 -Gesellschaftswissenschaften
Angewandte Therapiewissenschaften -Logopädie
Neustadtswall 30
28199 Bremen
w.scharff.rethfeldt@hs-bremen.de