what is

Developmental Language Disorder (DLD)

Developmental Language Disorder (DLD) stands out as a condition because it is accompanied by comorbidities, meaning it often coexists with other neurodevelopmental disorders. Language difficulties frequently coexist with Dyslexia, Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Developmental Coordination Disorder (DCD). DLD primarily manifests as challenges in verbal communication.
The problems associated with language can be categorized into two main axes:

Surface Structure of Language

This includes difficulties with the phonological aspects of language, such as speech sounds, articulation of language, vocabulary knowledge, and grammar usage that affect the actual production and comprehension of language.

Deep Structure of Language

This involves the semantic and syntactic aspects of language, such as understanding and using complex sentence structures, interpreting figurative language, and grasping the meaning and context of words and sentences beyond their literal interpretation.

Understanding these axes helps in assessing and addressing the specific language difficulties experienced by individuals with DLD, facilitating targeted interventions to support their language development.

Articulation Issues / Surface structure of language

Articulation issues in Developmental Language Disorder (DLD) fall under the surface structure of language. It’s the child who may struggle to pronounce certain consonants or vowels accurately. He might confuse sounds, such as mixing up “f” with “th” or “v”, swap syllables in words when speaking, or mix up and substitute consonants with vowels. These specific difficulties in articulation and/or in transposition and substitution of letters, or syllables can vary greatly from child to child.
Many children display these endearing speech patterns as they begin to talk. Parents should monitor their child’s verbal development paying attention to when they start speaking and how they articulate their first words. Rather than correcting them directly, a more advisable approach is to repeat what they’ve said correctly, in the form of a question.
By around the age of 2.5 years, it is recommended to consult an experienced Speech Therapist to evaluate whether targeted interventions are needed for the child’s articulation difficulties. Children with articulation issues often have unclear or hard-to-understand speech, which may lead to frequent corrections or teasing from peers. As a result, they may avoid asking questions during a critical stage of language development when they should be seeking answers and they may withdraw from speaking altogether.
Untreated articulation disorders can affect a child’s communication, socialization, and academic performance. According to DSM-V (2013), a child’s speech should be comprehensible by the age of 4. Therefore, early diagnosis and intervention before school age are crucial to mitigate potential emotional impacts.
During the assessment, the Speech Therapist should also investigate whether bilingualism is present in the family and determine the child’s primary language. They will assess whether the articulation issues are isolated or part of broader concern of oral motor skills, examining aspects like lip, teeth, jaw, tongue, palate function, and breathing. Children with articulation problems often also experience difficulties related to the surface structure of language, which can significantly impact their reading and writing, particularly in understanding the relationship between phonemes (sounds) and graphemes (written symbols). Speech Therapists often refer to this challenge as phoneme-grapheme awareness.

Problems with the Semantic and Pragmatic Dimension of Language / Deep Structure of Language

In Developmental Language Disorder (DLD), challenges extend beyond articulation to encompass semantic, conceptual, and pragmatic aspects of language. These difficulties are influenced by the brain’s executive functions such as attention, concentration span, verbal sequencing (syntax), and memory.

It’s the child who struggles to recount personal experiences, describe images, or summarize movies they’ve watched. Finding the right words to name objects or express requests proves challenging. Generally, his vocabulary is more limited compared to his peers. For instance, he may have difficulty vividly describing a recent birthday party, including details such as the games played, people in attendance, the appearance of the cake, or the celebrant.
It’s the child who, in an academic setting, has difficulty to explain his day, or comprehend why he was reprimanded by a teacher. He might grasp only that he was scolded without understanding the reason behind it. Sequencing events during a school excursion or providing a comprehensive detailed overview— such as describing participants, observations, explanations received, and memorable moments—poses significant challenges.
Furthermore, he may struggle understanding the purpose of activities, like field trips or the meaning behind what they observe, often interpreting information in his own personal way. He might not fully grasp the content presented during these trips or fail to connect what he is told with what he see. Similarly, when watching movies, he may find it challenging to articulate the main theme or follow the progression of the storyline accurately.
In addition, he struggles to find the right words, organize sentences syntactically, or substitute words that sound similar to the ones he intends to use. Usually, he interprets language literally, which can lead to questions in the classroom that may puzzle teachers or peers, who might wonder if the child is joking. This literal interpretation can also result in misunderstandings and occasionally provoke aggressive reactions in conversations with peers.

As a result, these children often face mutual misunderstandings with friends, parents, teachers, and school staff. Misinterpretations can lead to bullying, conflicts, and the formation of cliques. The child may inadvertently provoke reactions from others without realizing it, which can further complicate their social interactions.

Addressing this dimension of DLD requires interventions that support semantic understanding, conceptual reasoning, and pragmatic language skills. Understanding and managing these challenges can significantly enhance the child’s ability to navigate social interactions and academic tasks effectively.

Educators often perceive students with Developmental Language Disorder (DLD) in the deep structure of language as indifferent, unengaged, or even oppositional and aggressive behaviors. However, these behaviors may mask their struggles to comprehend spoken or written language and effectively articulate their thoughts.

As these children start school, anxiety, low self-esteem, and lack of confidence often become apparent. However, this unique difficulty is not always easily recognized by parents or educators, which can delay diagnosis. Concerns are typically raised by only a few perceptive educators and often not until the child reaches middle or high school.
Due to their ability to mask difficulties early on, these children are sometimes misdiagnosed with ADHD. It is crucial for Child Psychiatrists, Early Years Psychologists, and Clinical Child Psychologists to discern the subtle differences in language acquisition and expression between DLD and ADHD, particularly in cases where attention deficit is prominent. Understanding the psycho-emotional state of these children and adolescents is essential, as anxiety can manifest as withdrawal, aggression, or even delinquent behavior.
Early intervention and accurate diagnosis are of paramount importance for supporting children with DLD. Educators and caregivers play a vital role in recognizing and addressing these challenges to ensure that affected children receive the necessary support and accommodations to thrive academically and socially.
An accurate diagnostic process requires an interdisciplinary approach which involves assessing multiple facets of the child’s development:
Firstly, evaluating the child’s intellectual potential (IQ) provides insights into their cognitive abilities and potential strengths
Secondly, a thorough assessment of the child’s psycho-emotional profile by a Clinical Child Psychologist is crucial. Unlike general psychologists, Clinical Child Psychologists specialize in understanding the complexities of childhood development and emotional well-being.
Additionally, conducting a comprehensive learning assessment tailored to the child’s age and developmental stage is essential. For preschool-aged children, this assessment should ideally be performed by a Pedagogical Psychologist who specializes in early childhood education and developmental psychology.

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