Speak Out August 2018

Developmental Language Disorder (DLD) A further response to member enquiries A s most members will be aware, the CATALISE project was started in 2016 by Professor Dorothy Bishop from Oxford University and colleagues to try and reach agreement on

Functioning, Disability and Health (WHO ICF)” (CBOS p.12). These requirements are aligned with the recommendations of the CATALISE group who recommend that “Multiple sources of information should be combined in assessment, including interview/questionnaires with parents or caregivers, direct observation of the child, and standardized age- normed tests or criterion-based assessments.” (Recommendation 10, p.11). When interpreting assessment results from a child you suspect may have DLD, the guidelines specify that diagnosis should be based on both test performance as well as the functional impact of the difficulties (academic and/or socio-emotional impacts). Further, the CATALISE guidelines state that there is no commonly agreed upon cut-point score to distinguish between an impairment in language, and the lower end of normal variation. (For example, the ICD-10 recommends a score on an individually administered norm referenced test should be 2 SD below the mean, while Tomblin et al. (2010) have developed the EpiSLI criterion, based on composite scores from standardised tests of language, using a criterion of 2 or more composite scores falling more than 1.25 SD below the mean). Please refer to Ebbels (2014) for a discussion around these diagnostic criteria. Instead of a single cut-off point, as CATALISE reinforces, we are advised to consider norm-referenced test scores as part of a broader clinical picture. Clinicians are advised to use an omnibus / comprehensive norm-referenced language test (assessing language skills across the domains [semantics, syntax, morphology, phonology, and pragmatics] and modalities to obtain a ‘total language score’. In addition, naturalistic language samples, observations, and case history information, from the perspectives of multiple stakeholders including the child, parent/ guardian, preschool educator and other health professionals, provide valuable insights regarding the functional implications of the language disorder (see Bishop et al, 2016; Supplementary Comments, Q 10, p.11). In summary, there is no single test nor cut-off score that should be used to inform a diagnosis of DLD. Instead, clinicians should use information from multiple sources to not only appraise a child’s language performance across domains and modalities, but also determine the functional impact of the child’s receptive and expressive language challenges.

how to identify and talk about children’s language problems. The CATALISE consortium consisting of a group of 57 international experts in child language disorders from a range of professional disciplines completed two studies (Bishop,et al., 2016, 2017) and recommended adoption of the term Developmental Language Disorder (DLD). In the two previous articles in Speak Out (February 2017 and December 2017), speech pathologists were encouraged to start using the term 'language disorder' for children who have language problems that are likely to persist into middle childhood and beyond; with significant consequences on their everyday social interactions and/or educational progress. DLD refers to those language disorders that are not associated with a known biomedical condition such as brain injury, neurodegenerative conditions, genetic conditions, or chromosome disorders such as Down syndrome, sensorineural hearing loss, Autism Spectrum Disorder, or Intellectual Disability. In other words, DLD can be used when the Language Disorder cannot be explained as part of a known biomedical condition or an acquired neurological injury. In response to the worldwide debate regarding DLD, National Office has been contacted by several members to shed light on a range of issues. This column will focus on two main issues: Diagnosis of school-aged children with DLD, and the implications of the CATALISE recommendations for children in the preschool years. Future columns will explore other issues raised by members around implications of the CATALISE recommendations. When and how to diagnose a child with DLD? Several questions pertained to the use of a cut-off in standard scores when using norm-referenced tests such as the CELF-P2 or the CELF-4. As speech pathologists, we receive referrals from a range of sources including caregivers, teachers, and health professionals. CBOS (2011) reminds us that we need to “use the best available evidence to underpin our assessment” (p. 12). Additionally, we are expected to conduct comprehensive assessments that “include components of International Classification of

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August 2018 www.speechpathologyaustralia.org.au

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