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

© The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).Background: For many years research and practice have noted the impact of the heterogeneous nature of Developmental Language Disorder (also known as language impairment or specific language impairment) on diagnosis and assessment. Recent research suggests the disorder is not restricted to the language domain and against this background, the challenge for the practitioner is to provide accurate assessment and effective therapy. The language practitioner aims to support the child and their carers to achieve the best outcomes. However, little is known about the experiences of the language practitioner in the assessment process, in contrast to other childhood disorders, yet their expertise is central in the assessment and diagnosis of children with language disorder. Aims: This study aimed to provide a detailed qualitative description of the experiences of speech and language therapists involved in the assessment and diagnosis of children with Developmental Language Disorder. Methods & Procedures: The qualitative study included three focus groups to provide a credible and rich description of the experiences of speech and language therapists involved in the assessment of Developmental Language Disorder. The speech and language therapists who participated in the study were recruited from three NHS Trusts across the UK and all were directly involved in the assessment and diagnosis procedures. The lengths of practitioner experience ranged from 2 years to 38 years. The data was analysed using a thematic analysis in accordance with the principles set out by Braun & Clarke (2006). Outcomes & Results: The data showed a number of key themes concerning the experiences of speech and language therapists in assessing children with Developmental Language Disorder (DLD). These themes ranged from the participants’ experiences of the barriers to early referral, challenges for assessment and the concerns over continued future support. Conclusions & Implications: This study provides first-hand evidence from speech and language therapists in the assessment of children with Developmental Language Disorder, drawing together experiences from language practitioners from different regions. The findings provide insight to the barriers to referral, the potential variations in the assessment process, the role of practitioner expertise and the challenges faced them. The importance of early intervention, useful assessment tools and future support were expressed. Taken together, the results relate to some issues to be addressed on a practical level and a continuing need for initiatives to raise awareness of DLD in the public domain.Peer reviewe

Sleep behaviour relates to language skills in children with and without communication disorders

BACKGROUND: Sleep problems are common in children with autism spectrum disorder (ASD). There is also emerging evidence that sleep quality influences language learning in typical development. However there is a gap within the literature in regards to sleep and developmental language disorder in children (DLD). OBJECTIVES: The aims of this study were to: i) compare sleep patterns of children with communication disorders to the sleep patterns of their typical peers, and ii) ascertain whether sleep patterns related to language in this sample. METHOD: The relationship between sleep and language was investigated via parental questionnaires. There were sixty-five child participants in total aged between 3-18 years. Parents reported on 28 children with a developmental communication disorder (CD; ASD n=8 or DLD n=20) and 37 who were typical developing. RESULTS: The children with a developmental communication disorder showed more sleep problems than their typical peers particularly in terms of getting to sleep and early waking. Furthermore, significant correlations were found between sleep behaviour and language for children in both groups. CONCLUSION: Children with CD may have poorer sleep patterns than their typical peers which could compound developmental language difficulties

Comorbidity and diagnosis of developmental disorders

This chapter explores two main themes in two separate sections. The first section explores some of the challenges involved in the diagnosis of complex developmental disorders such as specific language impairment (SLI), developmental dyslexia, attention deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD). The second section of the chapter will consider the issue of co-morbidity between developmental disorders, and discuss the various models that have been proposed to explain potential overlap

Multi-level evidence of an allelic hierarchy of USH2A variants in hearing, auditory processing and speech/language outcomes.

Language development builds upon a complex network of interacting subservient systems. It therefore follows that variations in, and subclinical disruptions of, these systems may have secondary effects on emergent language. In this paper, we consider the relationship between genetic variants, hearing, auditory processing and language development. We employ whole genome sequencing in a discovery family to target association and gene x environment interaction analyses in two large population cohorts; the Avon Longitudinal Study of Parents and Children (ALSPAC) and UK10K. These investigations indicate that USH2A variants are associated with altered low-frequency sound perception which, in turn, increases the risk of developmental language disorder. We further show that Ush2a heterozygote mice have low-level hearing impairments, persistent higher-order acoustic processing deficits and altered vocalizations. These findings provide new insights into the complexity of genetic mechanisms serving language development and disorders and the relationships between developmental auditory and neural systems

The development of metaphorical language comprehension in typical development and in Williams syndrome

The domain of figurative language comprehension was used to probe the developmental relation between language and cognition in typically developing individuals and individuals with Williams syndrome. Extending the work of Vosniadou and Ortony, the emergence of nonliteral similarity and category knowledge was investigated in 117 typically developing children between 4 and 12 years of age, 19 typically developing adults, 15 children with Williams syndrome between 5 and 12 years of age, and 8 adults with Williams syndrome. Participants were required to complete similarity and categorization statements by selecting one of two words (e.g., either “The sun is like ___” or “The sun is the same kind of thing as ___”) with word pairs formed from items that were literally, perceptually, or functionally similar to the target word or else anomalous (e.g., moon, orange, oven, or chair, respectively). Results indicated that individuals with Williams syndrome may access different, less abstract knowledge in figurative language comparisons despite the relatively strong verbal abilities found in this disorder

Applying Item Response Theory (IRT) Modeling to an Observational Measure of Childhood Pragmatics: The Pragmatics Observational Measure-2

Assessment of pragmatic language abilities of children is important across a number of childhood developmental disorders including ADHD, language impairment and Autism Spectrum Disorder. The Pragmatics Observational Measure (POM) was developed to investigate children's pragmatic skills during play in a peer-peer interaction. To date, classic test theory methodology has reported good psychometric properties for this measure, but the POM has yet to be evaluated using item response theory. The aim of this study was to evaluate the POM using Rasch analysis. Person and item fit statistics, response scale, dimensionality of the scale and differential item functioning were investigated. Participants included 342 children aged 5-11 years from New Zealand; 108 children with ADHD were playing with 108 typically developing peers and 126 typically developing age, sex and ethnic matched peers played in dyads in the control group. Video footage of this interaction was recorded and later analyzed by an independent rater unknown to the children using the POM. Rasch analysis revealed that the rating scale was ordered and used appropriately. The overall person (0.97) and item (0.99) reliability was excellent. Fit statistics for four individual items were outside acceptable parameters and were removed. The dimensionality of the measure showed two distinct elements (verbal and non-verbal pragmatic language) of a unidimensional construct. These findings have led to a revision of the first edition of POM, now called the POM-2. Further empirical work investigating the responsiveness of the POM-2 and its utility in identifying pragmatic language impairments in other childhood developmental disorders is recommended

Development of a language and communication screening test and identification of protective and risk factors associated with communication and language disorders

With the present research, we aimed to identify the principal risk and protective factors associated with the occurrence of a developmental language disorder and to develop a specific and sensible screening instrument, easy and rapid to use. We can understand language disorders as a condition that involves poorly developed grammatical patterns, odd conversational patterns, misuse of words with respect with their meaning, difficulty expressing or following ideas and an inability to follow directions (Matson & Neal, 2010). On the other hand, communication disorders refer to a break in the communication chain (Morris, 2005). We know that delays in communication are the most prevalent symptoms in young children with developmental disabilities (Wetherby & Prizant 1996) and speech and language delay affects 5 to 8 percent of preschool children, often persists into the school years, and may be associated with lowered school performance and psychosocial problems (U.S. Preventive Services Task Force, 2006). The recent investigation in this field tells us that the early identification and intervention of children with language disorders is a urgent situation, because of the related consequences of this kind of developmental disorder (reading disorders, emotional disorders, academic achievement). Developmental delays in infants and toddlers are significantly under identified, which means that the provision of early intervention is prohibited for many children and families in need of services (Wetherby et al, 2002). In a previous investigation, we concluded that there is a gap between the early concerns of parents and the intervention of 20 months (Peixoto, 2007). The research tells us that we can early identify language disorders trough prelinguistic Predictors of Language Outcomes, and they are: • Joint attention and intentional communication • Language understanding • Play • Phonological development. Early identification of most medical problems is advantageous in that it generally provides better opportunities for successful intervention, Yet, involves several considerations as economical, ethical and methodological However, a major problem in screening for communication and language disorder is that it implies a matter of degree. To implement a screening policy we have to decide on a proper “gold standard” instrument, as well as deciding on cut-off scores (Eriksson et al, 2010). Regarding this we have developed an epidemiological study, with a prospective cohort design, with 431 children between 12 and 36 months old (394 evaluated in kindergarten and 37 evaluated in child placement homes) Children were first assessed between February and July of 2011, and 33% of the children had a second evaluation between January and March of 2012. The children were first assessed with our screening instrument, and their parents completed a questionnaire with information about pregnancy, birth, ESE, development, temperament and occupation. Our screening instrument gathers information about the child's abilities from multiple sources; caregivers participate in the assessment process and measures milestones that provide important information about prelinguistic and early linguistic development. The second evaluation consisted in a gold standard language test. Every participant was informed of the aims and procedures of the study, and everyone agreed to participate. Because of this study, we believe that we will be able to recognize risk groups for developmental language disorders and then propose a screening policy for risk groups for the early identification of developmental language disorder

Foreign accent syndrome: A typological overview

Foreign Accent Syndrome (FAS) is a motor speech disorder which causes patients to speak their native language with an accent different from speakers belonging to the same language community: the patient lacks the ability to make the phonemic and phonetic contrasts of his/her native language and demonstrates suprasegmental alterations which cause listeners to perceive the accent as distinctly ‘foreign’. In 1982, Whitaker proposed 4 diagnostic criteria for FAS: 1) the accent is considered by the patient, acquaintances and investigators as foreign, 2) it is unlike the patient’s accent before the insult, 3) the accent is clearly related to central nervous system damage, 4) there is no evidence in the patient’s background of him/her being a speaker of a foreign language (pp. 197- 198). Although FAS of “acquired neurogenic origin” is the most common variant of the disorder, there exists a “developmental”, “psychogenic” and “mixed variant” as well (Verhoeven and Mariën, 2010). In FAS of neurogenic origin the foreign accent is incited by a lesion affecting the central nervous system, often a stroke or brain trauma. However, FAS has also been attested in relation to MS (Villaverde-Gonzalez et al., 2003), tumor (Masao et al., 2011; Tomasino et al., 2013; Abel et al., 2009), as well as other pathologies affecting the CNS. Developmental FAS can be regarded as a subtype of neurogenic FAS; only here it is developmental in nature, affecting speech as it develops. In the psychogenic variant, a psychological/psychiatric disorder incites FAS, whereas the mixed variant is originally neurogenic in nature, but the accent change has such a profound effect on the patient’s psychological status that he/she internalizes it by further developing the accent in order ‘to create a more “believable” personality’ (Verhoeven and Mariën 2010, p. 600

Foreign accent syndrome as a developmental motor speech disorder

Introduction: Foreign Accent Syndrome (FAS) is a relatively rare motor speech disorder in which the pronunciation of a patient is perceived by listeners of the same language community as distinctly foreign. FAS has been well documented in adult patients with etiologically heterogeneous, though mostly vascular brain lesions affecting the motor speech network of the language dominant hemisphere. In addition, reports exist of adult patients in whom FAS was due to a psychiatric illness. Although FAS has been reported in children, such accounts are rare and have remained largely anecdotal in that there have been no formally documented cases of FAS as a developmental motor speech disorder. Methods and results: For the first time, we describe the clinical, cognitive and neurolinguistic findings in two patients who in the absence of a history of psychiatric illness or acquired brain damage already presented with FAS at an early stage of speech and language development. In the first patient “developmental FAS” was associated with a dysharmonic distribution of neurocognitive test results indicating slight underdevelopment of visuo-spatial skills and visual memory. The second patient presented with “developmental FAS” associated with specific language impairment (SLI). Independent support for a diagnosis of FAS in both patients was obtained in an accent attribution experiment in which groups of native speakers of (Belgian) Dutch assessed the type of foreign accent of a sample of the patients’ conversational speech. Both patients were judged as non-native speakers of Dutch by the majority of participants who predominantly identified the accent as French. Conclusion: This paper for the first time documents two patients who presented with FAS on a developmental basis. The finding that FAS does not only occur in the context of acquired brain damage or psychogenic illness but also exists as developmental motor speech impairment requires a re-definition of FAS as a clinical syndrome