Speak Out August 2018

4. The term DLD should be used for school-aged children who are identified as described in Point 1. Four to five year olds could also be identified with the term DLD if their language profile is reflective of a disorder that is likely to persist, is impacting function, and is in keeping with a DLD. For children younger than three, it could be more appropriate to describe their communication status (i.e., strengths and weaknesses across language domains and expressive and receptive modalities – in line with a descriptive developmental approach) and refer to them as having Speech, Language and Communication Needs (SLCN) or for toddlers as late-talkers, unless otherwise indicated.

What to "call" preschoolers with language difficulties Turning to our second issue for this column, there has been much discussion about implications for children under five years of age, and whether to ‘label’ these children as having a DLD or whether we should use other terms like 'delay' or 'impairment'. Both Bishop et al. (2016) and Reilly et al. (2010) remind us that when we consider late talkers at 18-24 months of age, it is difficult to identify those who will go on to have longer term problems. It is helpful to consider the red flags discussed in the research, such as poor language comprehension, poor use of gesture, and/or a family history of language disorders, which can improve prediction of language disorder. However, it is recommended that children of this age be termed ‘late talkers’ and are re-assessed after six months unless of course, the presence of these red flags or significant speech production, social interaction or cognitive difficulties warrants otherwise. Please refer to the bibliography below for access to Research Snapshots on late talkers. Predicting the natural course of a language disorder does start to become easier in four to five year olds. In general, language problems that affect a wider range of skills are likely to persist and children who show poor language skills at the age of four are unlikely to catch up without intervention. The CATALISE Consortium (2016) did not find evidence to support the commonly held belief that there are children with a flatter language profile (perhaps considered delayed) versus a more spiky one (to be considered disordered) – see Supplementary Comment to question 15 (p. 12). The evidence generally shows that the more domains of language that are involved (e.g., syntax, semantics, morphology), the higher the likelihood is that the language difficulties will persist. Based on these findings, the use of the term ‘language delay’ is not recommended. In summary, we recommend that: 1. The term language disorder be used for children who have language problems that are likely to persist into middle childhood and beyond; with significant difficulties evident in everyday social interactions and/or educational progress. DLD is used to refer to those Language Disorders that fit with this description where these difficulties 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. 2. Assessment needs to consider “Multiple sources of information…., including interview/questionnaires with parents or caregivers, direct observation of the child, and standardised age-normed tests or criterion-based assessments.” 3. Test scores on a single norm-referenced assessment should not be considered in isolation. We should not over- rely on the scores from a language test as it only provides part of the data to support diagnosis.

Mary Claessen, Curtin University Natalie Munro, University of Sydney Suze Leitao, Curtin University Tanya Serry, La Trobe University Marleen Westerveld, Griffith University m.westerveld@griffith.edu.au

References (open access) Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T. & The CATALISE Consortium. (2016). CATALISE: a multinational and multidisciplinary Delphi consensus study: Identifying language impairments in children. PLOS One , 11(7), http://dx.doi.org/10.1371/journal. pone.0158753 Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & the CATALISE Consortium (2017). Phase 2 of CATALISE: A multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology. Journal of Child Psychology and Psychiatry , 58(10), 1068-1080. https://onlinelibrary.wiley.com/doi/ abs/10.1111/jcpp.12721 Ebbels, S. (2014). Introducing the SLI debate. International Journal of Language and Communication Disorders . 49, 377-380. http://onlinelibrary.wiley.com/doi/10.1111/1460- 6984.12119/full McKean, C., Mensah, F. K., Eadie, P., Bavin, E. L., Bretherton, L., Cini, E., & Reilly, S. (2015). Levers for language growth: Characteristics and predictors of language trajectories between 4 and 7 years. PloS one , 10(8), https://doi. org/10.1371/journal.pone.0134251 McKean, C., Reilly, S., Bavin, E. L., Bretherton, L., Cini, E., Conway, L., . . . Wake, M. (2017). Language Outcomes at 7 Years: Early Predictors and Co-Occurring Difficulties. Pediatrics , 139(3). http://pediatrics.aappublications.org/ content/139/3/e20161684.long Reilly, S., Wake, M., Ukoumunne, O. C., Bavin, E., Prior, M., Cini, E., . . . Bretherton, L. (2010). Predicting language outcomes at 4 years of age: Findings from Early Language in Victoria study. Pediatrics , 126(6), http://pediatrics. aappublications.org/content/126/6/e1530 Speech Pathology Australia (2011). Competency-based occupational standards for speech pathologists: Entry level. Retrieved from http://www.speechpathologyaustralia. org.au/library/Core_Assoc_Doc/CBOS_for_Speech_ Pathologists_2011.pdf Late talker Research Snapshots, available from: https://www.mcri.edu.au/sites/default/files/media/documents/ crec_rs2_late-talkers-1_design_v0.1_0.pdf

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August 2018 www.speechpathologyaustralia.org.au

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