DLD 2024-25 Developmental Differences (1) PDF

What do you know about Developmental Language Disorder (DLD)? 🞂 https://radld.org/about/dld/dld-quiz/ Let’s start 🞂 Spend 3 minutes completing the quiz 🞂 Any surprises; any incorrect answers – with a…Quiz! we can discuss...

What do you know about Developmental Language Disorder (DLD)? 🞂 https://radld.org/about/dld/dld-quiz/ Let’s start 🞂 Spend 3 minutes completing the quiz 🞂 Any surprises; any incorrect answers – with a…Quiz! we can discuss 1  Developmental Language Disorder (DLD) Sarah Spencer Speech and Language Therapist Lecturer in Speech and Language Therapy  What is Developmental Language Disorder (DLD)? What are the features of DLD? Session outline What is the impact of DLD? What are controversies around a diagnosis of DLD? RADLD Group of academics raising awareness of DLD. https://radld.org/ Spend some time exploring the website and watching videos Terminology A term used, particularly in UK schools, is Speech, Language and Communication Needs (SLCN). This umbrella term is used in relation to children and young people who struggle to communicate, whether this is due to ‘social or environmental causes, neuro-developmental difficulties or sensory impairment’ (Bercow 2008: 3). Terminology: Speech, language and communication needs Speech-sound (SLCN) disorders: DLD - Verbal dyspraxia (CAS) - Articulation disorder Language disorder - Orofacial associated with… (known structural defects biomedical condition) Fluency disorders Voice disorders Language Lack of difficulties in familiarity under-5s with with ambient few risk factors language Adapted from Bishop et al. (2016) The Communication Chain Language is complex! Lots of expressive and receptive skills happening with very fast processing speed. Lots of opportunities for the chain to break down. You are probably an excellent communicator… Which may mean some of this is taken for granted Adapted from Elklan Introducing Children may have difficulties with: language Phonology. Syntax. disorder Semantics. Pragmatics and social use of language. Discourse. Verbal learning and memory. Reading and writing. Processing. Differs between individuals - We need to work out the unique profile of strengths and needs  Adapted from Ebbels. (2020). Diagnostic terminology Diagnosing DLD or Language Disorder (associated with X). Accessed from https://www.rcslt.org/wp- Child with language difficulties that: content/uploads/2020/11/DLD-when-is- - Significantly impair social and/or a-diagnosis-appropriate-slides.pdf educational functioning - With indicators of poor prognosis - Not explained by lack of familiarity with ambient language Language Disorder Associated with a known biomedical condition? no yes Developmental Language Language Disorder Disorder (DLD) Associated with X*… ‘Language disorder associated with’: Known genetic condition (e.g. Down syndrome, Klinefelter syndrome) Cerebral Palsy Acquired brain injury ‘Associated with’ does NOT Sensorineural hearing loss mean ‘explained by’ Severe intellectual disability Autism Not exclusionary factors  Adapted from Ebbels. (2020). Diagnostic terminology Diagnosing DLD or Language Disorder (associated with X). Accessed from https://www.rcslt.org/wp- Child with language difficulties that: content/uploads/2020/11/DLD-when-is- - Significantly impair social and/or a-diagnosis-appropriate-slides.pdf educational functioning - With indicators of poor prognosis - Not explained by lack of familiarity with ambient language Co-occurring disorders, e.g: Language - ADHD Disorder - DCD - Dyslexia - Dyspraxia Associated with a known - Speech biomedical condition? - SEMH no yes Developmental Language Language Disorder Disorder (DLD) Associated with X*…  There is often not an obvious or clear General cause for the language disorder considerations These children do not follow the typical rate and progress of speech and language development for DLD These children will not catch up and the disorder will persist throughout the child’s life. Some children with a language disorder will also have a significant learning disability. Some children with a language disorder will not have a significant or other learning disability. DLD outline and clinical guidance is available via the RCSLT (sign in): https://www.rcslt.org/members/clinical-guidance/developmental- language-disorder/ Bishop DVM, Snowling MJ, Thompson PA, Greenhalgh T, CATALISE consortium (2016) CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children. PLOS ONE 11(7): e0158753. https://doi.org/10.1371/journal.pone.0158753 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0158753 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0158753  Child with language difficulties that: - Significantly impair social and/or educational functioning - with indicators of poor prognosis - Not explained by lack of familiarity with ambient language Language Disorder Associated with a known biomedical condition? no yes Developmental Language Language Disorder Disorder (DLD) Associated with X*… Indicators for poor prognosis - further assessment useful Described as 'red flag' behaviours which are regarded as ’definitely atypical’ at this age. Note that these items describe a consensus view of clinicians, rather than empirically validated criteria. It is also important to stress that many children who exceed Based on Visser-Bochane MI, Gerrits E, Schans CP, Reijneveld SA, Luinge MR (2016) Atypical these minimum levels of speech and language development: a consensus language and communication study on clinicus signs in the Netherlands. Int J Lang Commun Disorder. nevertheless have language disorder. Cited in Bishop et al. (2016) Between 1 and 2 years of age Between 1 and 2 years of age, the following features are indicative of potential difficulties with speech, language or communication: (a) No babbling (b) Not responding to speech and/or sounds (c) Minimal or no attempts to communicate Between 2 and 3 years of age Between 2 and 3 years of age, any of the following features is indicative of difficulties with speech, language or communication: (a) Minimal interaction; (b) Does not display intention to communicate; (c) No words; (d) Minimal reaction to spoken language; (e) Regression or stalling of language development. Between 3 and 4 years of age Any of the following features are indicative of difficulties with speech, language or communication: (a) At most two-word utterances; (b) Child does not understand simple commands; (c) Close relatives cannot understand much of child's speech Between 4 and 5 years of age Children's language can change dramatically, especially in the preschool/early school years (aged 4 to 5 years), even if there is no intervention. ‘Severe’ language impairment involving both comprehension and expression is more likely to be persistent. Between 4 and 5 years of age Any of the following features are indicative of difficulties with speech, language or communication: (a)Inconsistent or abnormal interaction; (b) At most three word utterances; (c) Poor understanding of spoken language; (d) Strangers cannot understand much of child's speech; (e) Close relatives cannot understand more than half of what child says 5 years onwards Any of the following features are indicative of difficulties with speech, language or communication: (a) Difficulty in telling or re-telling a coherent story (producing narrative) (b) Difficulty in understanding what is read or listened to (c) Marked difficulty in following or remembering spoken instructions (d) Talking a lot but difficulties with engaging in reciprocal conversation (e) Many instances of over-literal interpretation, missing the point of what was meant. (Prediction of prognosis increases 5 years onwards) Activity 1: DLD videos We need to understand the unique profile of strengths and needs for each child with DLD For each of these clips, what did you notice about the child’s language skills? A 4 minute clip of a 10-year-old girl, described as having expressive language disorder (and showing some word-finding difficulties): http://www.youtube.com/watch?v=BnRNeDtme0g And a 4-year-old boy described as having receptive/expressive language disorder (6½ minutes): http://www.youtube.com/watch?v=oEyHNmlOiDs Activity 2: Signs of DLD (previously SLI) Watch this clip (Signs of SLI on youtube) https://www.youtube.com/watch?v=JAsf_Wqjz4g&t=220s What are the signs of SLI (now DLD)? Full video (7 mins): https://youtu.be/JAsf_Wqjz4g 27 DLD and Grammar L1 H. Girl and Mummy. Have tea. L2 H. Girl pour tea from teapot L3 H. (laughs) Girl spill tea. L4 Adult Why did she spill it? L5 H. It go on the tablecloth L6 Adult Why though? L7 H. Cos the girl pour the tea L8 Adult What will her mummy say? L9 H She will be cross. She angry. NB: H speaks each word as a single word with equal stress to every other word and with a pause before and after it. DLD and Grammar Potential difficulty with verb endings and syntax. They might leave out “is” and “are,” or not put an “s” on the end of a verb when they should. Later stage of sentence development - words are left out. As they get older, they may avoid complex sentence/utterance structures. DLD and Word Finding Difficulties Example: “Sleeve end” for “cuff” “protecting mask” for “helmet” “frame” for “buckle” “cast” for “sling” “treacle treat” for “trick or treat” “horse and carrot” Example: “They floated down in a erm…what's it called again…I forgot…in something whatever it is that” Video - https://www.youtube.com/watch?v=_y7TJ7Th8cY 30  How a word is stored In young children, a representation consists of the semantic information and the phonological information The word ‘apple’ A lexical - Semantic information – round, green, eat it representation - Phonological information – starts with ‘a’ sound and has two beats (syllables) For adequate storage, this information needs to be complete If it is not complete then the child will find it difficult to access and say the word correctly 31 DLD and Word Finding Difficulties 1. Child is trying to say the word ‘ice skating’ ‘I can’t do that thing…erm…you know…where you put sharp shoes on…I always fall over’ 2. Child is trying to say the word ‘plum’ ‘Well, I don’t really like that one which smells like soil and is purple and juicy’ 3. Child is trying to say the word ‘moustache’ “beeyer , stash, boustashe, beeyer, beeyerd, stash, stas, boustase” (Constable, 2001 - Chapter 10 in Stackhouse and Wells 2, 2001) 32  Examples of word finding difficulties (3) “They er…was…er....going to make some /boks/ and was rolling it out because that’s what you do first and he was reading the menu as well and then they were er…er…er….printing them out and then they put them in the oven because they’ll taste crunchy and then er…then they took them out of the oven so they could....er…..get..cool down and then you would take them” The words underlined show word finding difficulties – are they semantic or phonological or both? 33 What work do Facilitate inclusion for children with DLD speech and Provide specialist interventions for children with DLD language Work in partnership with teachers and families (and others!) to: therapists do? Remove barriers for learning for children Support the development of spoken and written language development Assess students and provide detailed information about their strengths and difficulties Advocate for specialist educational provision  Identification and diagnosis What work do Regular monitoring of progress and modifications to management speech and Support transition points e.g. from home to nursery, from primary school to secondary language school and from secondary to post-16 provision. Devising and deliver pathways and programmes therapists do? of therapy Supporting schools to integrate strategies into the curriculum in order to foster children’s language learning and use Maximising communication potential by skilling others in their use of facilitative strategies and/or use of augmentative communication systems Raising awareness, support and train professionals in identifying and working with children with developmental language disorder Supporting parents Facilitating communication in functional settings  Working on understanding of time concepts Today / yesterday / tomorrow Individual Understanding of Blank’s levels of questioning level Using Shape Coding by Susan Ebbels TM to work on syntactic targets examples Increasing word finding proficiency Teaching tier 2 words include: Teaching verbs Delivering narrative interventions for a range of targets Working on a functional target (e.g. the bus home / lunchtimes) Developing comprehension monitoring strategies Write social stories to work on scenarios that are causing difficulties Support to understand diagnosis or profile of strengths and needs  Sharing information with all teaching staff about communication profiles / strategies / inclusion School level Advocating for pre-teaching curriculum-relevant language examples Increasing use of visual supports across the curriculum include: Increasing use of communication supporting strategies during teacher talk Inputting into literacy/oracy support Allow more time for processing questions and forming responses Alert students to the content of likely questions when presenting new information i.e. what they should listen out for Demonstrating, mentoring and coaching learning support staff Joint planning/Team teaching  Co-professional practice SLT’s can provide teachers/parents with training/advice on how to use visual support and language strategies with children. However, the research suggests that the impact is small unless training is followed up with coaching, observation & feedback. (Ebbels et al., 2019 – page 7, ‘Evidence of the effectiveness of Tier 1 interventions’) Slides 39-44 - We will whizz through these today but you can revisit independently - Examples of supportive strategies - Speech and language therapy students will get more information on intervention for DLD in Key Clinical Topics 2  Aspects of new word – semantic / phonological / morphological / grammatical / orthographic Explicit discussions + Mapping word opportunities to onto action derive meaning Principles of word Repeated learning Transferrable exposure across word learning contexts strategies Generalisation Deep to real-life understanding contexts Strategies Give definitions Display key words Give examples Discussion with a visual image..Related to the Teach how to derive Encourage students List key words on word through meaning from to draw on personal the board scaffolded morphology experience… questioning Students to Students write the Students say the generate their own word word aloud definition Teaching words Classroom strategies Use visual support: Use software like Boardmaker to generate symbols….. Or a good old fashioned Google Image search Visuals are permanent Allow extra time for processing Act as a memory support Prepare for transition Now: Next: Can be consistent across lessons Scaffold independence  Classroom strategies Use the child’s name to draw attention of the child Use eye contact / get down to their level Use natural gesture Use symbols and props Encourage new words Provide ‘scripts’ Now it is xxx time. What do we do first? Use contrast to highlight differences in lexical items / syntactic structures Praise listening Praise turn taking Classroom strategies Pace: use a slow pace during conversation and give children plenty of time to respond and take turns Pause: pause expectantly and frequently to encourage turn taking Confirm: Respond to their utterances – don’t ignore communication bids Comment – comment on what the child is doing at the time Extend – repeat what the child says and add a small amount of information Label – lots of opportunities to label actions, objects, concepts  DLD is heterogeneous and individuals with DLD present with a range of speech, language and communication strengths and difficulties. Word finding difficulties are often a feature of DLD and these can be semantic, phonological or both. The psychometric approach is/has been used to identify SLI - exclusionary and discrepancy Conclusions criteria This psychometric criteria now questioned, particularly the role of non-verbal IQ in the discrepancy criteria Much recent debate about the appropriate terminology to use (following the IJLCD special issue 2014) Consensus to move to using the term DLD with a different diagnostic criteria to SLI. 46 Follow up - core reading Read through the two excellent RCSLT webinar packs (saved on Blackboard) Read through the two excellent case studies of children with DLD (saved on Blackboard) Recommended Reading McGregor, K. K. (2020). How we fail children with developmental language disorder. Language, Speech, and Hearing Services in Schools, 51(4), 981-992. Bishop, D. V., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & Catalise Consortium. (2016). CATALISE: A multinational and multidisciplinary Delphi consensus study. Identifying language impairments in children. PLOS one, 11(7), e0158753. Questions….? Thank you Thank you for your time and energy… Keep in touch! [email protected]