What is DLD: heterogeneity in developmental language ... · CATALISE 1: Criteria for identification - summary. Refer for evaluation Assessment of speech, language and communication

What is DLD: heterogeneity in developmental

language difficulties?

Maggie Snowling CBE FBA

St. John’s College &

Department of Experimental Psychology

University of Oxford

Hypothetical 8-yr-old: George

2

• Late to start to talk

• Didn’t speak in sentences until 4 years old

• Otherwise developed normally

• Weak vocabulary for his age

• Struggles with reading: has extra support

• Doesn’t always remember what his teacher

says

• Teased for not understanding jokes

• Loves art and constructing things

• Parental concern; he is now reluctant to go

to school

• Hates being singled out and made to feel

different from others.

Would George benefit from any kind of label?

3

• Speech, Language and

Communication Needs (SLCN)

• Specific Language Impairment

(SLI)

• Social Communication Disorder

• Developmental dyslexia

• Something else

• None of the above

4

Labels used for unexplained language problems

Prefix Descriptor Noun

Google Scholar: 1994-2013.

Of 168 possible combinations, 130 found at least once.

33 distinct terms were used 600 times or more during that period

The CATALISE project : What we did and why we did it

With thanks to

Dorothy V. M. BishopDepartment of Experimental Psychology,

University of Oxford

5

Why we need to get criteria and terminology sorted out

6Sense that some children who would benefit are denied services

Lack of recognition of children’s language difficulties

– the ‘taxi-driver’ test

The

language

we use

affects

the

services

that

children

get

Can’t do

research

without

common

definitions

specific language

impairment

developmentaldysphasia

SLCN

languagedelay

NIH funding over time for neurodevelopmental disorders

7

$K

0

100000

200000

300000

400000

500000

600000

700000

800000

900000

2000-

2001

2002-

2003

2004-

2005

2006-

2007

2008-

2009

Attention deficit

hyperactivity

disorder

Autistic spectrum

disorder

Dyslexia/SLI/speech

/dyscalc/DCD

Data from: Bishop, D. V. M. (2010). Which neurodevelopmental

disorders get researched and why? PLOS One, 5(11), e15112. doi:

10.1371/journal.pone.0015112

Implications

of Labelling?

https://www.google.com/url?sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwjr4ZDQy7fbAhULOxQKHdzrC5UQjRx6BAgBEAU&url=https://www.pinterest.com/pin/530439662333681475/&psig=AOvVaw3yByDEZhnryFba83AjQV03&ust=1528118598458709

Tension between education and medicine

Education

• General dislike of medical labels

• Prefer ‘needs’ or ‘problems’ to ‘disability’ or ‘disorder’

• Focus on social rather than biological causes

• Want to avoid stigmatisation

Medicine

• Diagnostic labels

– International Classification of Diseases (ICD10)

– DSM5

• Emphasise neurobiological origins/genetics

9

• Language skills are dimensions

• No clear cut-off between ‘impaired’ and ‘typical’ development

• Focus on deficits rather than on multifactorial models

• Behavioural symptoms differ over time, labels do not

10

Tension between research and practice

• “To the extent that clinical economy depends on getting the right treatment to the right people, clinicians are…categorisers. At a purely practical level this depends on a judgement being made that such and such a child belongs to the category of those who ‘need help’, whereas another child belongs to a (usually) larger category who do not.” (p. 117).

11

Sonuga-Barke (1998) Categorical models of childhood disorder:

a conceptual and empirical analysis. Journal of Child Psychology

and Psychiatry, 39, 115-133.

Positives?

Two things we can all agree on?

• There are children who have difficulties with oral or written language that are serious enough to affect everyday life and academic outcomes and are not just a consequence of poor schooling/parenting

• We should do our best to help these children overcome these difficulties: doing nothing is not an option

Bishop, D. V. M. (2014). Ten questions about terminology for children with unexplained

language problems. International Journal of Language & Communication Disorders,

49(4), 381-415. doi:10.1111/1460-6984.12101.

Questions we need to be able to answer

• Which children should get extra help?

• Audit: how many SLTs do we need?

• Is rate of language problems increasing/decreasing over time?

• How do different countries/region compare?

• What causes children’s language problems?

Can only

answer these

if we have

common

criteria for

identifying

problems and

common

language for

referring to

them

No perfect answer!

GOAL: Find an agreed way of identifying and talking about children who need services

WHILE

Minimising negative impact of labels:

❖Misunderstanding

❖ Denial of services

❖ Stigmatisation

15

Maggie

Natalie

Gina Courtenay Becky

Beth

Raising Awareness of Language Learning Impairments: the start

2012

https://www.google.com/url?sa=i&source=imgres&cd=&cad=rja&uact=8&ved=2ahUKEwjSwf6b0rLbAhXLtRQKHeVqDoIQjRx6BAgBEAU&url=https://en.wikipedia.org/wiki/Dorothy_V._M._Bishop&psig=AOvVaw3cFRXuTb0dBBS24fXJGg-C&ust=1527948596073969

16

https://www.youtube.com/RALLIcampaign

Aims of RALLI (now RADLD) campaign

• Raise awareness of language impairments through YouTube

• Sort out the mess in definitions and terminology

CATALISE: How it happened

17

• Special issue of International Journal of

Language and Communication Disorders

• Internet forum/Twitter debate

• Delphi: CATALISE

a) On criteria (published 2016)

b) On terminology (published 2017)

Sheena Reilly

Susan Ebbels

Our approach to building consensus

Assemble a group of experts and use the Delphi method to have an online discussion

Key feature of Delphi: everyone rates and comments on initial set of statements, and sees everyone else’s responses, but whole process is

anonymous.

18

Trisha Greenhalgh

Full details online

19

CATALISE Phase 1: Who Needs Help?

20

Who is on the expert panel?

• Wanted to cover a range of countries and a range of professions, including teachers, paediatricians, psychologists, and representatives of parent-support organisations.

• Most participants were speech-language therapists/pathologists – this is the professional group who has most involvement with assessment and intervention

• Restricted to English-speaking countries for the time being

21

International Expert Panel• English-speaking countries

• Authors of the commentaries in the IJLCD special issue

• Additional panel members recruited from under-represented categories

DisciplineCountry

TOTALAus Canada Ire NZ UK USSLT 3 1 3 4 15 6 32

SLT/Psychology 2 3 0 0 2 0 7

Psychology 1 3 0 0 3 1 8Spec. teacher 0 0 0 0 2 0 2

Audiology 0 0 0 1 0 0 1Paediatrics 0 0 0 0 3 0 3

Psychiatry 0 1 0 0 1 0 2

Charity 0 0 0 0 4 0 4

TOTAL 6 8 3 5 30 7 59

Examples of Statements 1

• The overlapping subsets shown in Figure 1 all refer to problems with language. The generic term Language Impairment is recommended for situations where it is useful to adopt a broad category, where there is difficulty differentiating types of language difficulty, or where difficulties affect many domains of language.

23


• The grey area shows cases where the main problems are in the language learning domain (as evidence by tests of memory and learning and/or lack of response to intervention). For such cases we propose the term Language Learning Impairment

24


• 8. For policymakers, it can be useful to have a broad category that encompasses the full range of language problems ..and also includes cases where problems have a clear physical basis (e.g. dysarthria), affect speech fluency, voice or auditory perception, or involve other aspects of communication (e.g. use of augmentative or assistive technologies). The term Speech, Language and Communication Needs (SLCN), already in use in educational services in the UK, is recommended for this purpose.

• 11. In clinical contexts, there does not seem any justification for allocating services according to whether language difficulties are primary or secondary.

• 12. In some contexts (e.g. research on aetiology), one may wish to restrict consideration to cases who do not have any known risk factors, and in other contexts it may be useful to make explicit that there is a lack of risk factors.

25

Delphi for CATALISE 1: criteria

27

Round 1 Round 2

CATALISE 1: Criteria for identification

Refer for evaluation

Assessment of speech, language

and communication

Identification of additional

factors

Concern about speech, language or

communication

OR

Behavioural or psychiatric difficulties

‘Late

talker’

under 2

yr old

• Need information from multiple sources: caregiver report,

observation, standardized tests, language learning context

• Language is complex: need to consider content, form and

use; receptive as well as expressive

• Pragmatics and phonology as well as grammar/vocabulary

• Verbal learning and memory as well as static performance

Reassess

later

• Co-occurring problems in motor skills,

attention, reading, social interaction,

nonverbal skills and behaviour problems.

• Check for associated known conditions –

genetic syndromes, ASD, acquired brain

injury, hearing loss

CATALISE 1: Criteria for identification - summary



and communication


factors


communication

OR


‘Late

talker’

under 2

yr old







Reassess

later










and communication


factors


communication

OR


‘Late

talker’

under 2

yr old







Reassess

later








CATALISE Phase 2: Terminology

31


• 2: The term 'language disorder' is proposed for children who are likely to have language problems enduring into middle childhood and beyond, with a significant impact on everyday social interactions and educational progress.

• 3: In general, poor receptive language and language problems that affect a range of functions are indicators of poor prognosis, especially in a school-aged child. (NB If the panel agrees with this approach, this statement will be elaborated further).

• 4. The traditional view of exclusionary factors for diagnosis can lead to denial of services to children who might benefit from intervention.

• 5. Some children may have language needs in the classroom because their first or home language is not the language used in the classroom, and they have had insufficient exposure to the language of instruction to be fully fluent in English. This should not be regarded as language disorder, unless there is evidence that the child also has difficulties in the home language.

32


• 10. The term developmental language disorder is proposed to encompass cases of language disorder with no differentiating factors.

• 13. Co-occurring disorders are impairments in other cognitive or behavioural domains that can co-occur with language disorder and may affect prognosis, but whose causal relation to language problems is unclear. These include attentional problems, motor problems, literacy difficulties, speech difficulties, executive impairments, limitations of adaptive behaviour and/or behavioural problems.

• 14. A child with a language disorder may have a level of nonverbal ability at the low end of the normal range. This does not preclude a diagnosis of language disorder.

• 16. Nested within the category of developmental language disorder, more specific terms can be used to pinpoint the principal areas of language difficulty. These would be in addition to, rather than instead of, the term 'developmental language disorder', acting as optional descriptors.

• 33

Terminology

• Statement 16. Nested within the category of developmental language disorder, more specific terms can be used to pinpoint the principal areas of language difficulty. These would be in addition to, rather than instead of, the term 'developmental language disorder', acting as optional descriptors.

• Statement 17. Where the child’s speech production is characterised by phonological errors, we propose the term Phonological Disorder.

• Statement 18. Phonological Disorder is a subset of the category of Speech Sound Disorder, which is a term in widespread use. This encompasses phonological disorder, but also includes problems with speech production that have their origins in motor or physical problems, rather than having a linguistic basis.

• Statement 19. For cases of language disorder where the main problems are with pragmatics/social communication and who do not meet diagnostic criteria for Autism Spectrum Disorder, we propose the term Pragmatic Language Impairment.

• Statement 20. The majority of children with developmental language disorder have problems in processes of verbal learning and memory. For these children we propose the term Language Learning Impairment.

34

Two terms rejected at an early stage

• Dysphasia

• Language Delay

35

3 terms over which panel were split

36

These proposed

specific labels!

37Round 1

CATALISE 2: Items focused on terminology

Round 1

Items 13-15 proposed

specific labels: virtually

equal 3-way split!

Specific language impairment (SLI)

Advantages

• Most common term in academic settings, though less widely used in clinical and educational practice in UK.

Disadvantages

Too exclusive: ‘Specific’ often taken to mean that child

(a) has a substantial discrepancy between language and nonverbal ability and

(b) has no other difficulties

– this excludes many children from services

• Research on genetics and intervention does NOT support distinguishing children with and without verbal-nonverbal discrepancy

38

Primary language impairment

• Not widely used: 362 hits on Google scholar search

• Used by Boyle et al (2007) to refer to language difficulties that are not secondary to another condition, without requiring a discrepancy with nonverbal ability

PROBLEMS

• People may think ‘primary’ refers to school-aged

• People may interpret to mean language is the child’s primary problem –subtly different meaning from ‘not secondary to other condition’

• Not always easy to judge if a language problem is secondary to another problem

• Potential for confusion with ‘pragmatic language impairment

39

Developmental language disorder• Advantages

– Descriptive, without implying anything about causes

– This term will be used in ICD-11 (and also more compatible with DSM5 ‘language disorder’)

• Disadvantages

– Objections to ‘disorder’; too medical, disease focused; implies qualitative rather than quantitative differences between children

– May encourage old idea of ‘delay’ vs. ‘disorder’

– Affected children grow up: ‘developmental’ may be seen as inappropriate for teenagers/adults

40

41

The Bottom Line:

Consensus on terminology

Language Disorder

Speech,

Language and

Communication

Needs

Language Disorder is a subset of broader category of SLCN

43

Language Disorder

Developmental Language Disorder

Language Disorder

Speech,

Language and

Communication

Needs

DLD is a subset of Language Disorder

Associated with

biomedical condition, X*

Language

disorder

Child with language difficulties that:

• impair social and/or educational

functioning

• with indicators of poor prognosis

Developmental

language

disorder (DLD)

Language

disorder

associated with X*

*includes genetic syndromes, a sensorineural hearing loss,

neurological disease, ASD or Intellectual Disability

Important!

Not exclusionary

factors.

Child eligible for

assessment/

intervention

Starting point

Associated with

biomedical condition, X*

Language

disorder

Child with language difficulties that:

• impair social and/or educational

functioning

• with indicators of poor prognosis

Developmental

language

disorder (DLD)

Language

disorder

associated with X*

*‘Associated with’ does NOT mean ‘explained by’

Important!

Not exclusionary

factors.

Child eligible for

assessment/

intervention

Hypothetical 8-yr-old: George

46

• Late to start to talk

• Didn’t speak in sentences until 4 years old

• Otherwise developed normally

• Weak vocabulary for his age

• Struggles with reading: has extra support

• Doesn’t always remember what his teacher

says

• Teased for not understanding jokes

• Loves art and constructing things

• Parental concern; he is now reluctant to go

to school

• Hates being singled out and made to feel

different from others.

Would your answer to previous questions be any different if George had...

47

• Autistic features

• A moderate+ sensorineural hearing loss

• Language problems after traumatic brain

injury

• Polish-speaking parents with poor

English

• A chaotic and impoverished home

background

• A score of 80 on a nonverbal IQ test

• Attentional problems

CATALISE panel suggested those in red might indicate a different intervention pathway

Exclusionary criteria misused in three ways

1. Presence of risk factor taken to mean it is whole explanation for poor language

2. Presence of risk factors used to deny services to children

48

87% agreement that allocation of

services should not depend on whether

language impairment primary or secondary

to other cause

CATALISE panel: 98% agreement that

presence of a risk factor does not mean it

necessarily explains child’s difficulties

49

This definition very broad: need additional information

Nature of language impairments

• Phonology

• Syntax

• Semantics

• Word finding

• Pragmatics/language use

• Verbal learning & memory

Decided against subtypes –

too many children don’t fit

neatly!

Risk factors

• Family history

• Poverty

• Low level of parental education

• Neglect or abuse

• Prenatal/perinatal problems

• Male

Co-occurring disorders

• Attention

• Motor skills

• Literacy

• Speech

• Executive function

• Adaptive behaviour

• Behaviour

What is new?

• Developmental language disorder (DLD) to replace SLI

• Disorder defined in terms of functional impairment and poor prognosis

• Rather than exclusionary factors, ‘Language disorder associated with X’ – also need assessment/intervention

• Does not use invalid delay/disorder distinction

• Does not use social background as criterion

• Does not use nonverbal IQ as criterion 50

Conclusion

51

Remember! Not a single, homogenous condition, and no

label is perfect.

Hope is that we can agree to go with the consensus and so

move forward to raise awareness, improve services to

children, and do much-needed research

We are pleased to announce that your article

Phase 2 of CATALISE: a multinational and

multidisciplinary Delphi consensus study of

problems with language development:

Terminology, published in Journal of Child

Psychology and Psychiatry, was one of the

journal’s top 20 most downloaded recent papers!

In 2017-2017 your article had received 6563

downloads.

Impact!

Sweden translated the #catalise

statements and asked people to rate them.

Largely agree with consensus (25/27

statements)

Disagree on discrepancy and

comorbidity

Italy preparing for a consensus conference

in Nov/Dec 18 #LDG7

Greek SLTs considering the issue

Follow Susan Ebbels on Twitter

@SusanEbbels

Open Science Framework

https://osf.io/5exq4/

https://twitter.com/hashtag/catalise?src=hash

https://twitter.com/hashtag/LDG7?src=hash

https://twitter.com/SusanEbbels

https://twitter.com/SusanEbbels



Language and Dyslexia: current research

Dyslexia and Language Disorder

• Three hypotheses regarding relationship:

– Dyslexia is the developmental outcome of a language disorder

– Dyslexia is a mild form of language disorder

– Dyslexia and Language disorder co-occur (co-morbidity)

+

P-

Language Comprehension

Phon

olo

gy

L- +

Dyslexia

Poor comprehender Typical

Relationship between SLI and dyslexia(after Bishop & Snowling, 2004)

Dyslexia + poor

reading comprehension

• Family Risk of Dyslexia• Pre-school LD • Children at low-risk of RD

Phase 2

4 ½ yrs

Phase 35 ½ yrs

Phase 46 ½ yrs

Phase 58 yrs

Phase 1

3 ½ yrs

TDN=69

FR+LIN=29

FRN=83

LIN=32

Language deficits:VocabularyGrammar

Comprehension

Phonological Deficits:

Articulation (Speech)

Word and NonwordRepetition

Morphology (t1)

Speech and Language Delays inPreschool (t1,t2)

Nash, Hulme, Gooch & Snowling, 2013 JCPP

82 %

5 %

5 % 8 % FR

54 %

7 %

21 %

18 %

LI

Gooch, Hulme, Nash & Snowling, JCPP 2013

Co-morbidities?Motor and Executive Attention

motor

EF

Language: Sets the Stage for Reading

• Articulation (pcc)

• Word repetition

• Nonword repetition

• Vocabulary

• Sentence recall

• Receptive grammar

• Basic concepts

Language & Phonology: One Factor or Two?

environment

genes

• Articulation (pcc)

• Word repetition

• Nonword repetition

• Vocabulary

• Sentence recall

• Receptive grammar

• Basic concepts

NW Rep (PM)

Word Rep

Articulation

.69

.76

.57

LANG

Sentence Structure

Sentence Recall

Vocab

.77

.77

.75

.37

.51

Basic Concepts

SPEECHmotor

.27

.56

. 81 Age 3½

SPEECH

PA

Phoneme Isol - End

Phoneme Isol - Beg

.14

.08

.42

.81.81

.48

GPC

LSKLetterwriting

.92 .91

.66.36

.70

RAN

Objects Colours

.90 .66

.03

Age 4½

LANG

Predictors of ‘Triple Foundation’

.38

LANG PA

Decoding.42

.48.18

.47

.40

GPC

.66

.36

.70

RAN

Age 8

Language as both a direct and indirect predictor of reading comprehension

Read Comprehension

T5

.38

.36

• Language is the foundation for learning to read

– Precursor to the development of phonological awareness

• The effect of language on decoding is viaPhonological Awareness and letter knowledge

• Poor language has a direct (+ a mediated) effect on reading comprehension

• Phonological deficits and Language problems place children at risk of dyslexia

Which children with preschool risks develop reading problems?

TDN=69

Family risk of dyslexia?

Control FRLanguage Concerns

FR+DLDN=29

DLD criteria?

DLDN=32

FRN=83

No Yes

recruitment

Study sample

Dyslexia Outcomes at Age 8

Specific Learning Disorder: Dyslexia

Pattern of learning difficulties characterized by problems with accurate or fluent word recognition, poor decoding and poor spelling abilities

• 1.5SD below the mean of the TD group on a composite of word reading/spelling (SS <= 88)

Dyslexia Outcomes at Age 8

0

5

10

15

20

25

30

35

40

45

TL LI

Lo Risk

FR

40%26%

7%

26%

Typical Language

Language Impaired

prevalen

ce

Family history and language skills are additive risk factors

DLD Outcomes at Age 8

CATALISEDevelopmental Language Disorder

Persistent difficulties with the use of language due to deficits in comprehension or production

• -1SD below the mean of the TD group on a composite measure of vocabulary, receptive and expressive grammar

‘DLD’ (age 3½)

DLD(age 8)

TD control - 5.5%

FR - 19%

LI 100% 74%

FRLI 100% 77%

Up to 50% of children with DLD in

preschool resolve their language

problems by school-age; i.e. before

age 8 when ‘dyslexia’ diagnosed

Late-onset DLD

• Ages 3½; 5½; 8 years

• Four trajectories:

– Typical Language: not LD

– Resolving LD

– Persisting LD

– Emerging LD -1.5

-1-.

50

.5

Lan

gu

ag

e C

om

posite

(zscore

)

1 3 5Time Point

TL Emerging

Persisting Resolving

Snowling, Duff, Nash & Hulme, 2016 JCPP

School entry

Co

mp

osite lan

guage z sco

re

Trajectory

[language]

N % males % FR

dyslexia

% SSD SES Comorbidy Dyslexia

outcome

TL 145

(66%)

54% 46% 14% .24a (.66) n/a 12%

Resolving 12

(6%)

75% 50% 42% .05a (.70) NO

Higher PIQ

8%

Emerging 21

(10%)

48% 76% 48% -.06 a (.79) 48%

Persisting 42

(19%)

79% 48% 57% -.32 (.84) YES

Lower PIQ

40%

RD * Language Outcome Age 8

Dyslexia by DLD status at age 3

Dyslexiaby DLD status at age 8

Low risk (TD)

7% 7.2%

FR 26% 17%

DLD 26% 35%

FR-DLD 40% 45%FR and DLD -- additive risk factors?

• Predicting from preschool, the risk of dyslexia is equal in those at family risk of dyslexia and those with language difficulties (‘DLD risk’)

• Dyslexia outcome is more likely in those with DLD at school age

• FR-DLD carries higher risk of dyslexia outcome, especially when DLD is persistent

• DLD at higher risk of poor reading comprehension

When does DLD become dyslexia?

76

Who is ‘At Risk’ of Dyslexia?

Persistent LD

• IF Phonological Deficits

• Executive and motor difficulties

• Lower PIQ

• Lower SES

Late-Emerging DLD

• Family risk of dyslexia

• Speech delay

• Phonological Deficits (specific, persistent)

48% dyslexia

Family Risk of Dyslexia

17% dyslexia

40% dyslexia

+

P-

Language Comprehension

Phon

olo

gy

L- +

Dyslexia

N=21

DLD-only

N=38

Control

Typical

outcome

N=63

DLD+Dyslexia

N=29

-0,5

0

0,5

1

1,5

2

2,5

3

3,5

4

4,5

t1 t2 t3 t4 t5 t1 t2 t3 t4 t5

Language Phonology

Effe

ct S

ize

of

De

fici

t

Effect size of d

eficit

Language

PhonologicalLanguage

DYS

DLD

DYS+DLD

Development of Language Skills

-0,5

0

0,5

1

1,5

2

2,5

3

3,5

4

4,5

t1 t2 t3 t4

GPC

-0,5

0

0,5

1

1,5

2

2,5

3

3,5

4

4,5

t2 t4 t5

RAN

-0,5

0

0,5

1

1,5

2

2,5

3

3,5

4

4,5

t2 t3 t4-5

PA

Development of Foundation Skills

0,00

0,50

1,00

1,50

2,00

2,50

3,00

3,50

4,00

4,50

t2 t3 t4 t5

Decoding

DYS

DLD

Comorbid

Development of Decoding

• In Dyslexia, phonological deficits observed from preschool onwards; broader oral language deficits increase over time

• Children with DLD show large deficits in language skills at all time points, increasing over time

• In DLD, phonological deficits decrease over time except when dyslexia is comorbid

– FR = risk of phonological deficit; poor letter/symbol learning

– DLD = phonological deficit as component of more general language disorder

Dyslexia and DLD – different etiology, shared risk factors for poor reading (poor phonology)

Dyslexia and DLD: Conclusions

• Heritable language learning impairments

– Shared ‘endophenotype’ = poor phonology

• Dyslexia can occur as a developmental outcome of language disorder

– Critical age hypothesis – dyslexia is probable if language difficulties persist until age of reading instruction (Bishop et al)

• Dyslexia and DLD often comorbid in school years

– Language disorder/difficulty may emerge later, particularly in children at family risk of dyslexia

Implications for

Theory, Policy &

Practice

Take Home Messages

• Language is multidimensional and DLD is heterogenous

• A consistent label is important to signal a functional impairment that requires intervention and may be persistent

• A ‘Simple View’ of Learning to Read is too simple

– Language is the foundation of decoding as well as reading comprehension

– Whether [or not] a child has a problem learning to read fluently depends on their language system at the point of reading instruction

• Developmental trajectories of phonological and broader language skills differentiate dyslexia and DLD and determine which children succumb to dyslexia/poor comprehension

Messages for Education

• Oral language skills are the foundation for the development of literacy skills and more broadly for the whole of formal education

• Interventions to improve oral language skills can be highly effective

• We have shown such interventions may be delivered effectively by trained and supported Teaching Assistants working in schools

• Improving oral language skills is important in its own right – but also transfers to improvements in reading comprehension

https://www.youtube.com/watch?v=PTrCEaW52Jw&feature=youtu.be

https://www.youtube.com/watch?v=10q6WMFnmzo

https://www.youtube.com/watch?v=PTrCEaW52Jw&feature=youtu.be

https://www.youtube.com/watch?v=10q6WMFnmzo

Conclusions for Practice • Clues (risks) as to which children will develop reading

problems can be inferred from early language development, phonological skills, family history and language background

• Monitoring children’s progress over time is essential if we are to provide support that is relevant and evidence-based at the right time and sustained when needed

BUT there is no quick fix: We need to NAME it and INTERVENEInterventions need to be of high qualityExcellent implementation is of key importance

Credits!Children, Families and Schools – Thank You!

Wellcome Team

• Charles Hulme• Emma Hayiou-Thomas• Hannah Nash• Fiona Duff• Debbie Gooch• Lorna Hamilton• Ruth Leavett• Piers Dawes• Katy Grainger• Samantha Hardwick• Isobel Chadwick• Sarah Watson• Chris Dixon• Kristina Moll• Paul Thompson • Maggie Snowling

Interventions Group

• Charles Hulme• Silke Fricke• Claudine Crane• Paula Clarke• Marina Puglisi• Carol Mesa• Dianne Newbury• Kelly Burgoyne• Marysia Nash• Rosanne Esposito• Denise Cripps• Maggie Snowling

Dorothy Bishop and her leadership of RADLD and CATALISE!

Thompson et al 2015 JCPP doi: 10.1111/jcpp.12412

Screening for Dyslexia

RISK FACTOR 1

Family-Risk

∙---∙---∙ FR

∆---∆---∆ not FR

RISK FACTOR 2

Language P [

Dysle

xia

]

Low High

low -> high

Family Risk & ‘Core Predictors’

Core PredictorsPhon AwLetter KnRapid Naming

Documents

What is DLD: heterogeneity in developmental language ... · CATALISE 1: Criteria for identification - summary. Refer for evaluation Assessment of speech, language and communication