Developmental Language Disorders

LEARNING OBJECTIVES
You will learn how to
• Discuss issues related to identification of young children with language impairment
• Provide an overview of specific language impairment
• Detail the language characteristics of young children with specific language impairment
• Discuss implications for intervention for young children with specific language impairment

DLD is an insidious, lifelong disability and its prevalence rate makes it the most frequently occurring of
all communication disorders, and it is one of the “most commonly occurring neurodevelopmental
disorders”

IDENTIFICATION OF CHILDREN WITH LANGUAGE IMPAIRMENT

children who are acquiring language normally can show marked variability in language
development - How do we determine if the difference is normal variation or problematic?

Mental Age, Chronological Age, and Language Age

Two standards of comparison:
mental age (MA) the age level at which a child is functioning on cognitive/intellectual tasks, that
is, intellectual level generally measured by intelligence tests
intelligence quotient (IQ) is a psychometric indicator that relates a child’s MA to CA
this means that children’s levels of language skills are viewed in terms of their cognitive
prowess
chronological age (CA) the age in years - language impairment is defined as a clinically
significant departure from what is expected for children of the child’s own CA

of these two standards of comparison, CA is generally the preferred and recommended standard for
comparison

Normal Variation, Normal Distribution, and a Statistical Approach

normal distribution of performance in samples of children of the same age with particular demographic
characteristics
mean and standard deviations (SD)
3;0, measuring receptive vocabulary size: 68% -1 - +1 SD = normal range of performance
13.5% -1 - -2SD
2.5-3% <-2SD

Concern about a child’s performance escalates the greater the child’s score is below the –1 SD point
Arbitrary cut-off points: “there is no intrinsic criterion for where to draw the line between ‘normal’ and
‘affected’”
-1 SD ≈ 85 standard score ≈ 17th – 18th percentile rank ≈ stanine 3
language impairment: a standard of comparison or cutoff at the 10th percentile ≈ -1.25SD = standard score
of 80-81
a score provides an estimate – measurement errors – Standard Error of measurement (SEM)
multiple forms of language assessment are required for accuracy
Non-specific Language Impairment (NLI): NVIQ –1- -2SD; Language -1SD

Social Standard
language and academic/social achievements
social standard: societal values (educational and social success)
harder to measure in numerical terms

Clinical Markers for DLD

a clinical marker is a behavioral feature or characteristic or a combination of particular features or
characteristics that children with DLD have
present or absent and so independent of the normal distribution of language ability
Challenging and Changing the Child’s Language Performance
When genetic factors are believed to underlie a clinical marker, the term phenotype may be used to refer
to the clinical marker
DLD clinical markers: verb tense morphology; nonword repetition (NWR); sentence recall
tasks examining 5-year-olds’ verb form marking abilities correctly identify 97% of children with
DLD and 98% of typically developing children
does not reach adultlike levels of accuracy by 8 years of age
2-year-olds at risk for DLD - later onset of tense marking
NWR requires children to repeat nonsense words of varying syllable length and
phonological complexity
restricted mostly to children of 5years and above
Syllable Repetition Test
sentence repetition and sentence imitation
in order to perform correctly, children need to rely on their morphosyntactic knowledge in long-
term memory

Clinical Markers for DLD:

1. identify young children who have DLD;
2. separate young children who have DLD from children who have other conditions, such as
ADHD; and
3. predict which children are at risk for language impairment and which might “outgrow” early
language delay.

Challenging and Changing the Child’s Language Performance

children at the lower end of ‘normal’ distribution are at risk
may experience difficulties with academic skills (reading, spelling, and writing), and with demanding
discourse language skills, such as narratives
Degree of difficulty in learning language targets can be measured in terms of
the speed with which new language skills are learned,
the amount of teaching effort that is needed, or
the accuracy of performance, that is, the quantity of learning

Risk Factors for Language Problems

there are very young and therefore primarily nonverbal children (e.g., below 1 or 1½ years of age) who
may be at risk for language development problems
possible to assign neonates to an “at risk for language problems” category based on criteria related to
prenatal and perinatal events
“preventive intervention”

At risk factors:
birth factors (e.g., anoxia, hyperbilirubinemia, and kernicterus),
chromosomal syndromes (e.g., Down syndrome)
known neurological or physical conditions (e.g., cerebral palsy, hearing loss, and cleft palate)
 socioeconomic factors
environmental deprivation
prematurity
Other at risk factors:
a family history of literacy problems and/or communication problems
birth order, with later birth indicating a greater risk; and
parents’ levels of education, particularly mother’s level of education
maybe gender (boys more at risk than girls)
??socioeconomic status
not all factors have been fully determined
Summary
Issues Explanations
Standards of Mental age (MA): language
comparison performance compared to
expectations for child’s mental
(cognitive) age
Chronological age (CA): language
performance compared to
expectations for child’s CA
Social standard: degree of social
value attached to verbal ability and
aspects of performance linked to
verbal ability (e.g., academic
achievement and social
relationships) and degree to which
language problems therefore
negatively affect achievement
Measures of Age equivalency (language age
performance [LA])
Variance measures (e.g., standard
scores, percentile ranks, standard
deviations, and stanines)
Clinical markers of Verb tense marking development,
DLD nonword repetition, and/or
sentence recall as possible clinical
markers of DLD, and maybe
phenotypes of DLD
Identifying Stress/challenge language
underlying performance
language problems
Considerations
Children with language performance higher than MA
Relationship between cognition and language not fully
established
Different forms of intelligence and relationship
with language not established
Children with intellectual disabilities potentially
excluded from being considered language impaired
Potentially excludes children with above-normal
cognitive abilities but with average or below average language
performance from being considered language impaired
Too many children identified as having language problems for
resources available
Implication that goal of intervention is always to achieve age-
equivalent language performance
Hard to measure numerically
Not a one-to-one relationship between variance score (e.g.,
standard score) of language performance and degree of impact
on child’s current and future life
Involves prediction with regard to future problems
child might have
Same amount of delay in terms of age equivalence
not equally important at different CAs
Normal variation in language performance not
considered
Cutoff point not descriptive of actual problems in real-life
language functioning Danger of excessive dependence on
norm-referenced,
standardized language tests
Assessment tools and procedures to use with very young
children still being developed
Reasons for verb tense marking, nonword repetition, and
sentence recall difficulties not fully known but presumed to
have underlying neurological bases, likely of genetic origins
Other clinical markers may be identified
Casual language performance and/or norm-referenced language
performance may appear normal unless performance stressed
to reveal underlying but real language problems

Predicting future Identifying children at risk for
language problems language difficulties; supplement
with screening programs
Subtle problems can affect language-related
academic skills (e.g., reading and spelling)
At-risk factors not completely identified
Relationships between factors not fully understood

AN OVERVIEW OF DEVELOPMENTAL LANGUAGE DISORDER

Delay versus Disorder

language delay implies that language skills are slow to emerge or develop
language disorder denotes a deviance in the usual rate, trajectory, and/or sequence with which specific
language skills emerge - there may be less of an inference that children might just catch up with their
language, with or without intervention.
confusion arises as one aspect or component of language will negatively affect other aspects so that the
entire language performance appears disturbed

Subgroups of Young Children with Developmental Language Disorder

Two likely subgroups have been implicated, although the relative degrees of difficulties (e.g., lexical
retrieval, syntax, and morphology) can vary from child to child:
1. Both comprehension and expression difficulties (i.e., receptive-expressive language disorder)
2. Expression difficulties (i.e., significantly less impaired receptive language with a sizeable gap
between it and the more severely impaired expressive language)
a third comprehension-only difficulties may sometimes show up as a subgroup in some literature.
the notion that children could have problems with expression in the absence of some comprehension
problems has come to be challenged
problems with our methods of assessing comprehension and language processing
or the limited number of available sensitive assessment tasks/tests for assessing young children
phonological problems
gestures representing symbolic play
socialization characteristics

A Label for It and Reasons for It

Neurological Bases
minimal brain dysfunction and minimal brain injury
neurophysiological measures during auditory and speech processing tasks and semantic and
grammatical processing tasks and fMRI/MRI findings for brain morphology and cerebral
functioning
 neurophysiological techniques with quite young children to look at the possibility of identifying
neurological bases that might eventually be used for early diagnosis of DLD
possible neurological changes occurring as a result of language intervention with children with
DLD

Language Knowledge and Access to Language Knowledge

children have difficulties abstracting from their language-learning environment the requisite implicit
language rules, demonstrate incomplete learning of rules, and/or have problems accessing language
information that they already know

Cognitive Deficits
deficits in particular aspects of cognitive functioning, such as symbolic play, hypothesis formation and
testing, and representational thought, have been associated with DLD in children
how testing of cognitive ability, particularly NVIQ, can be completely devoid of the influences of
language ability?

Information Processing Deficits

DLD in children stems from problems in how well the children can deal with (process) incoming stimuli
and/or use the stimuli in order to learn language and/or acquire information
generalized information processing limitations (working/short-term memory)
specific to particular processes, such as the temporal processing of rapidly changing auditory
stimuli or phonological processing
behaviorally, young children with DLD are described as being inattentive, especially to spoken language
(Central) Auditory Processing Disorder [(C)APD]
Attention Deficit/Hyperactivity Disorder (ADHD)
about 30 to 60 percent of ADHD co-occurrence rate with DLD

Language-Learning Environment
Overall, language-learning environment is not viewed as a probable reason for DLD.
Quantity of language exposure in the environment seems insufficient by itself to be a reason for DLD in
children
it might affect both normally developing and language-impaired children’s performances on common
measures of language, such as those involving lexical density (size of vocabulary) and length of
utterances
attributing the reason for children’s language learning problems to mothers’ communicative interaction
styles seems not to stand up consistently to empirical scrutiny
Recasts, responses to a child’s utterance that are semantically contingent and include language elements
the child used but add or modify the child’s utterance in some way that makes it more complex or
complete, as in the following:
Child: That my teddie.
Mother: Yes, that is your big teddie. We’ll take it in the car.
Mothers have been found to use recasts with children with DLD differently, including using them less
frequently – it could be that for use of recasts specifically, mothers are responding to the older ages of
their children with DLD or their nonverbal cognitive levels rather than the children’s lower language
levels

Genetic/Familial Bases
language impairment has a tendency to run in families and that language-learning environmental
influences alone are insufficient to explain the children’s language-learning problems
In twin studies, two of the possible clinical markers noted
previously (nonword repetition and verb tense marking) have been found to have heritable bases for risk
for DLD
longitudinal genetic studies of DLD: utilize growth curve modeling for acquisition of certain language
skills tying genetic timing mechanisms at a molecular level in brain development to longitudinal
acquisition of specific language skills.
three regulatory genes—KIAA3019, CNTNAP2, and FOXP2—are candidate genes in the etiology of
DLD

nature vs. nurture

genetic and environmental factors may come together to affect a child’s language abilities and even
continue to have effects in subsequent generations

Prevalence
One of the earliest signs that a child may have problems with language is that the first word is used late or
that not very many additional words are acquired after the first word.

At 18–24 Months of Age

absence of a vocabulary growth spurt
failing to combine words into two-word utterances
generally talking very little
late bloomers
slow expressive language development (SELD)
At 3 Years of Age
about 20 and 75 percent of children who were slow in language development at 2 years of age moved into
the normal range on measures of expressive language at 3 years of age but about 25 to 80% of them
continue to show language delay after 3 years
reasons for the big range are the different tools that have been used to assess the children’s language,
including the varying degrees of specificity and sensitivity of the tools, the aspects of language that were
measured, and the degree to which language performance has or has not been challenged in the children
Language comprehension of young children is notoriously difficult to assess in toddlers in valid and
reliable ways
As children age, vocabulary size, at least as measured by many norm-referenced tests, is a less reliable
indicator of DLD than other language measures.

At 4 Years of Age
about 45 to 85 percent of 2-year-olds with SELD received scores within normal limits on measures of
expressive language at 4 years of age
children whose language abilities are behind those of their peers at 4 years of age may be in for long-term
problems – especially with literacy and narrative skills

At 5 Years of Age
many preschool children with language deficits (without nonverbal intelligence deficits) appeared to catch
up by 5½ years of age, but about an equal proportion (40 percent) do not
while many of these children score within normal limits on norm-referenced tests of language at 5 years
of age, most of their scores are in the lower range of normal and were significantly lower than their peers
who did not have a history of slow language development
importance of early intervention that tries to take advantage of the neurological plasticity of brains of
children younger than 5 years

Considerations and Implications

language deficits may change in their manifestations as children get older, thereby showing effects on
language performance differently for certain aspects of language behavior
in normal language development 5-year old children seem to plateau in their language but show a growth
spurt again between ages 6 and 7
those children who are better at language are better able to take advantage of language-learning
opportunities to learn more language, but those who are not good fall further and further behind, and the
gap between the language able and language limited children widens with time

Predicting Spontaneous Recovery from Early Language Delay

Intervention with toddlers and preschoolers has positive effects on their language and accelerates their
language, but we also know that intervention does not “cure” DLD
comprehension skills of 2-year-old children were significant factors in predicting their receptive and
expressive language abilities at 3 years of age
Some Factors Potentially Predicting Continuing Language Problems
Family history
Communicative intentions, symbolic gestures, and play
Babbling and phonology
Socialization and behavior
Comprehension
Clinical markers
Verb vocabulary size and growth
Responsiveness to trial intervention/dynamic assessment
Narrative production
Severity of delay
LANGUAGE CHARACTERISTICS OF CHILDREN WITH DEVELOPMENTAL LANGUAGE
DISORDER
not all children will necessarily demonstrate all possible problems
a problem with one aspect of language can result in problems with other aspects

Some Language Precursors

some preschoolers with DLD seem to have difficulty participating in
participating in reciprocal interactions
establishing joint reference with an adult
give-and-take play routines
repetitive games such as patty-cake
delayed bubbling

Phonology
toddlers and preschoolers with DLD frequently have concomitant phonological problems
most children identified as having phonological problems also have language impairments
it is not unusual to find 3- and 4-year-old children with DLD who are difficult to understand.
more likely to resolve as children mature
young children with DLD acquire more quickly single words that begin with consonants they use
correctly in other words than words that begin with consonants not yet produced correctly
about 20 to 30 percent of the preschool children who experienced phonological difficulties apparently not
related to concomitant problems in other areas received special education services when they entered
school

Semantics
delay in using the first word and being slow to add lots of words to their vocabularies

On average, using their first word at about 23 months of age, almost a year late
at 24 months of age an expressive vocabulary size of about 17 words compared to 128 to 193 for
normally developing children and at 36 months a vocabulary size of 197 words, similar to that of
normally developing children at 24 months
children with DLD having qualitatively different as well as quantitatively different vocabularies
young children with DLD are typically slower to begin to use two-word semantic relations (around 3
years of age)
difficulty in storing and/or retrieving new words
word-finding difficulties can show up when children are asked to name pictures particularly in timed
naming tasks
the connected speech of children with language problems is also often characterized by hesitations,
dysfluencies, reformulations, word substitutions, and fillers,
the children may use a substantially higher number of words without clear referents, such as thing, this,
that, here, and there.

Syntax and Morphology

deficit syntactic and morphologic skills are almost “classic” characteristics of preschoolers with language
impairments

Shorter length of utterances (MLU) than same-age peers

Syntactically simpler sentences, including limitations in the types of transformations used and limited
use of subordination
Omissions and/or confusions of grammatically obligatory elements, such as articles and noun plural
morphemes
Subject case marking problems, as in him for he and her for she when the pronouns are to serve as
subjects of sentences
Failure to consistently mark verbs for tense and number, with particular difficulties with both regular
and irregular past-tense marking

Patterns
Inconsistent errors
Errors of omission common
Errors of commission infrequent
Regular past-tense verbs problematic
Irregular past-tense verbs problematic
Case marking on pronouns related to verb marking
Inclusion of auxiliary verbs potentially susceptible to structural priming effects

surface account: inefficient processing mechanisms for weak non-salient morphemes

extended optional infinitive account: marking is treated as an optional rule for an extended period of time

by 8 years of age, while the frequency of failure to apply verb marking has declined considerably,
children with DLD still are inconsistent

implicit rule deficit account: children have difficulty abstracting the implicit rules that govern
grammatical morphology
dual mechanism account
connectionist account

Pragmatics and Conversational Interactions

Connection with ASDs?
A Summary of Pragmatic Difficulties
Functions and Intentions
Initiating Verbal Interactions
Responding to Others’ Verbal Interactions
Sustaining Verbal Interactions
Clarifying and Repairing
Adapting Messages/Code Switching
These patterns suggest a passivity in their interactions
assertiveness and responsiveness

Socialization and Psychosocial Factors

it is difficult to separate pragmatic difficulties from socialization and psychosocial factors that are
associated with DLD
there is a relationship between some degree of psychosocial involvement and language impairment
• Of 40 consecutive admissions to a child psychiatric unit, 50% of the children had language
problems
• Of approximately 300 successive intakes of children to a community-based speech and language
clinic, 95% of the children with expressive language problems had some form of psychosocial
difficulties
• 67% of the children consecutively admitted because of behavioral/emotional problems to an
inpatient facility failed a speech and language screening
communicative failures may result in psychosocial difficulties - psychosocial difficulties may be a part of
the syndrome of DLD
Some research findings
language delay in children between ages 18 and 35 months was not associated with behavioral/emotional
problems
no significant association was found between toddlers with slow expressive language learning and scores
in the problematic range on a parent-rating protocol of their child’s behavior, the Child Behavior
Checklist for Ages 2–3
behavioral/emotional problems of children with DLD are likely to emerge after children have lived with
language impairment for some time
withdrawn behavior/shyness is the one aspect of behavioral/emotional behavior that emerged as possibly
associated with language delay
withdrawn behavior may indeed prove to be a commonly observed socioemotional characteristic of
children with DLD.
DLD children demonstrate behaviors consistent with less sophisticated management of their emotions
than their typically developing counterparts

Narratives
relating understandable, complete narratives is an important factor in school achievement
children with language problems frequently have difficulty in telling good narratives
toddlers with SELD have been shown to have problems with narrative skills in the kindergarten years and
preschoolers with DLD often demonstrate difficulties with narrative skills.
narratives of children with DLD tend to contain less information than those of preschoolers with normal
language skills – maybe attributed to lack of complex sentences and high content words

IMPLICATIONS FOR INTERVENTION

Assessment
DLD in toddlers and preschoolers appears to be manifested in different ways at different times
DLD in toddlers and preschoolers appears to be manifested in different ways at different times

Toddlers
Assessment of toddlers needs to be multifaceted.
(1) socialization;
(2) phonological composition of vocalizations and babbling as well as verbalizations;
(3) use of gestures, particularly symbolic play gestures expressing script routines and those
gestures and behaviors associated with joint attention;
(4) behavior; and
(5) nonword repetition abilities now that there are a few tasks that appear appropriate for use with
 older toddlers.

comprehension skills need to be included as an important part of an assessment process

Information about a toddler’s comprehension skills can help inform about possible long-term language
and learning outcomes, is important in planning intervention, and can provide additional assessment
documentation of language problems

Young children’s uses of communicative intentions produced through gestures and vocalizations can be
assessed even before they use their first words
• Cuing (linguistic): Manipulate for minimal support using indirect model; manipulate for maximal
support using elicited imitation
• Activities (nonlinguistic): Manipulate for minimal support using novel activities; manipulate for
maximal support using known event routines and scripts
• Interactor (nonlinguistic): Manipulate for minimal support using clinician; manipulate for
maximal support using mother/caregiver
• Materials (nonlinguistic): Manipulate for minimal support using no toys or props; manipulate for
maximal support using familiar objects/toys and those with thematic base (e.g., doll, bottle,
and/or diaper)
• Interaction (nonlinguistic): Manipulate for minimal support using naturalistic child–adult
interactions; manipulate for maximal support using contrived tasks (e.g., desired food item in
transparent, tightly sealed container)

Early Language Milestones

Of particular import for assessing toddlers are milestones related to prelinguistic developmental
behaviors, early expressive vocabulary development, early and later multiword utterances, early emerging
grammatical morphemes, and early sentences.

at about 2 years of age a typical toddler is, in essence, “off and running” with regard to syntax and
grammar

utterance level productivity (ULP): general positional rules for word combinations
grammatic level productivity (GLP): specific rules based on semantic consistency
unique syntactic types: combination of two or more words with syntactic status that could fit into the
phrase structure of a more grammatically complete adult utterance
highly correlated with children’s performances on the Index of Productive Syntax and MLU

acquisition of early verb morphemes between 2 and 3 years of age

a comprehensive language sample that includes analyses of children’s verb forms is an essential aspect of
assessment for toddlers

Assessment Instruments and Parental Report

Several general assessment tools examining a range of developmental areas (e.g., gross motor, fine motor,
personal-social), including items that address communication skills:
Bayley Scales of Infant and Toddler Development—III
The Capute Scales: Cognitive Adaptive Test and Clinical Linguistic and Auditory Milestone
Scales
Vineland Adaptive Behavior Scales—III
Several communication-specific tools:

The Rossetti Infant-Toddler Language Scale

Early Language Milestone Scale (ELMS – 2)
 Communication and Symbolic Behavior Scales – Normed Edition (CSBS – Normed)
Sequenced Inventory of Communication Development—Revised
Preschool Language Scale—5 (PLS – 5)
Receptive-Expressive Emergent Language Test—Third Edition (REEL – 3)
Test of Early Language Development – 3 (TELD – 3)

the procedures for a number of these instruments include some degree of parental report as well as direct
professional–child interaction
parental reports have several inherent features that make them an attractive method of assessment:
(1) the parents have had more opportunities to observe their children’s language, so they
typically know more about what the children do with their communication than a professional
can learn in an assessment session;
(2) parental report can be obtained prior to professionals seeing the children and can, therefore,
help professionals plan assessment sessions; and
(3) it is cost effective.

Language Development Survey (LDS) (10 minutes)

MacArthur-Bates Communicative Development Inventories – 2 (CDI – 2) (30 minutes)
Provide parents with a list of vocabulary items (or phrases) and ask them to indicate which of the
words their children use

Parent/Caregiver–Child Interactions
few problematic
(1) the degree of directiveness in the parents’/caregivers’ interactions, with parents/caregivers of
language-impaired children tending to use more directive language to their children, such as
commands, rather than responses to their children’s initiations, and
(2) the frequency with which parents/caregivers provide semantically contingent responses
(recasts) to their children’s utterances

Preschoolers
for preschoolers, many more norm-referenced language instruments are available
as preschoolers mature much beyond 3 years of age, MLU may no longer be a consistently reliable
indicator of language growth
gross measures of expressive vocabulary size may be less reliable indicators of language skill
comprehension assessment needs to examine understanding whole units of language and understanding
across multiple utterances and examine a child’s ability to infer meaning.
assess children’s uses of complex sentences and the emergence of grammatical morphemes especially
their use of verb tense grammatical marking
literacy development

illusory recovery – false negative results

ensure that assessment is comprehensive
narrative production is challenging and thus important
use of clinical markers: NWR, verb morphology, sentence recall

Social Communicative Interaction

children should be assessed as they interact in a group with other children
Social Interactive Coding System (SICS): examines a child’s interactions with peers during a variety of
activities that typically occur in preschools, such as art, dramatic/symbolic play, and free play with toys
turn-taking aspects are measured
Intervention
Decisions about Intervention
under what conditions is intervention recommended,
when is intervention recommended, and
what is the nature of the intervention—monitoring, indirect intervention, or direct intervention
carried out by a professional

professionals need to be alert to what factors of children’s communication abilities they are judging with
regard to intervention recommendations
whatever initial decision is made, it is reassessed regularly as a child’s behavior does or does not change
ongoing monitoring,
regular measurements of a child’s language performance across many parameters,
consistent follow-up, and
flexibility in moving from one form of intervention to another

Indirect Intervention
Parents/Caregivers
parents/caregivers are potentially powerful sources of change in children’s communicative behavior
can augment, expand, and supplement the intervention provided directly by a professional or
can serve as the primary agents of change, with the professional serving to develop the initial
directions and methods for change and to monitor both the process and the progress
Must be educated in
creating or enhancing the child’s environment to facilitate change in the child’s language and
responding within that environment in a manner that optimally facilitates language change

seizing opportunities and capitalizing on language teaching moments

creating opportunities for language learning
reduce the frequency with which they use directive speech acts, including commands and
demands for responses from the children, and increase their use of
(1) responsive speech acts,
(2) information-seeking questions
(3) confirmation requests to affirm that the adult understood the child correctly, and
(4) simple recasts and expansions of the child’s
increase the frequency with which they respond to what the child says and to do so with semantically
contingent statements

Preschools
peers have been shown to be able to facilitate the language development and social interaction skills of
children with DLD or SELD
preschoolers behave as if they know who talks well and who doesn’t, and they prefer to interact with
those who do
facilitative adults in these settings need to develop strategies that specifically target encouraging
successful peer interactions
training to help teachers reduce some types of directiveness where it is not necessary for direct instruction
might enhance children’s language learning
the combination of parent/caregiver education and preschool programs provides more powerful
opportunities for enhancing children’s language performances than parent/caregiver education alone

Direct Intervention
can be contacted individually with a child or via group sessions or a combination
groups have a greater potential to
 facilitate children’s peer interactions,
assist them to use language appropriately in social interaction,
provide opportunities for generalization of language skills,
tend to have more naturalistic environments for language use and
are likely to include more events/experiences to talk about and more people with whom to talk

variations on group intervention for toddlers and preschoolers

(1) Some programs have smaller numbers of children in them while others are larger
(2) Some consist only of children with language delays or impairment; others have a mix of
children with and without language
(3) Some place greater emphasis on acquisition of grammatical forms others on vocabulary and
early word combinations and others on a wide variety of aspects of language based on
individual children’s needs
(4) As indicated above, some include individual intervention sessions with children as part of the
total intervention program; others use group sessions exclusively
commonalities
(1) most of the programs recognized the importance of peer interaction and socialization for the
children and addressed these in varying degrees in the intervention programs.
(2) Inclusion of routine events and scripts to help children scaffold their language and reduce
processing demands for them

SUMMARY
In this chapter we have seen that
• Characterization and understanding of DLD as a condition is far from complete; nevertheless,
DLD should probably best be thought of as a lifelong disability since it does not go away, even
though intervention can moderate its effects.
• There is doubt about the existence of expressive language impairment without some degree of
receptive language/comprehension/language processing involvement; comprehension is an
important part of thinking about DLD in young children.
• Several different labels to describe these children have been used; DLD has gained acceptance.
• Causal factors remain elusive, but information processing, neurological factors, and genetics are
promising candidates; these may not be independent causal factors but rather interrelated factors.
• Some children outgrow early delays in acquiring language; others do not. Predicting who will and
who will not catch up is an important area of research. Issues related to possible “illusory
recovery” need to be addressed. Issues of illusory recovery and prediction impact on assessment
strategies and intervention decisions.
• Three aspects of performance, morphology related to verb tense marking, sentence recall, and
nonword repetition, are possible clinical markers of DLD.
• Children with DLD can exhibit different combinations of communication problems that can
involve some or all parameters of language. One common feature is difficulty with syntax and
morphology and, in particular, verb morphology.
• Parental/caregiver involvement is important in obtaining assessment information, and
parental/caregiver education is an important aspect of intervention.
• Placement of children in preschools will not necessarily ensure successful social communicative
interactions unless these are specifically addressed within the preschool situation.
• A number of different intervention models are available, and which model is used should depend
on the needs of individual children and their parents.
• Intervention is a process of ongoing monitoring, regular measurements of the children’s language
performances, consistent follow-up, and flexibility in moving from direct to indirect intervention
modes and vice versa.
There is no question that toddlers and preschoolers with DLD are at risk for academic failure when they
begin school. They are also at risk for early social failure. Proper and early identification and intervention
are critical if a potential cycle of social and academic failure is to be thwarted.

Resources
Guardian Article
Developmental Language Disorder: The most common childhood condition you've never heard of

Videos
Developmental Language Disorder - What is it?
What is SLI?

Tools
Language and Working Memory Lab
Arabic Speech Language and Literacy Network