Developmental Language Disorder (DLD): Signs and Support

01DLD

What DLD means

The NIDCD defines DLD as a communication disorder that interferes with learning, understanding and using language. The language difficulties are not explained by other conditions, such as hearing loss or autism, or by circumstances such as a lack of exposure to language. DLD can affect speaking, listening, reading and writing. Northern Lincolnshire and Goole NHS Foundation Trust (NLG) describes it as a persistent difficulty with understanding or using language.

DLD is common: the NIDCD says it affects about 1 in 14 children in kindergarten. It has also been called specific language impairment, language delay or developmental dysphasia, although these older terms do not always mean exactly the same thing. The NIDCD describes it as a neurodevelopmental disorder: its exact causes are unknown, but it tends to run in families.

02Language skills

Understanding and using language

DLD can affect understanding language (receptive skills), using language (expressive skills), or both. NLG lists difficulties in these areas:

• listening to language and processing instructions or questions
• using language and talking in longer sentences
• learning new vocabulary
• using grammar when speaking
• reading and writing, which may become more evident as the child gets older
• attention and listening, and sometimes behavior, because of difficulty processing language

Not every difficulty with expressing words is DLD. The diagnosis applies when difficulties are persistent and affect everyday life, learning or social development.

03Signs

Signs across childhood and adulthood

The NIDCD explains that a child with DLD often has a history of being a late talker. Younger children with DLD may be late to put words together into sentences, struggle to learn new words and hold conversations, have difficulty following directions because they do not fully understand the words, and make frequent grammatical errors.

In older children and adults, common signs include limited use of complex sentences, difficulty finding the right words, difficulty understanding figurative language, reading problems, disorganized storytelling and writing, and frequent grammar and spelling errors. The NIDCD notes that language difficulties can be mistaken for shyness or misbehavior: a child who does not understand instructions may seem not to follow them, and a child who struggles to communicate may become frustrated and act out.

04Difference or disorder

Language differences versus disorder

Many toddlers start talking later than others. The NIDCD explains that some late talkers eventually catch up with their peers, while children with DLD have persistent language difficulties. Being a late talker does not mean a child has DLD, but persistent difficulties should not be dismissed. Our guide on the late talker explains early language milestones.

NLG notes that children diagnosed with DLD are over 5 years old and have a longer-term difficulty. This refers to when the diagnosis is usually confirmed, not to a reason to wait: the NIDCD stresses that early treatment during the preschool years can improve the skills of many children with language delays, so concerns in a younger child are worth assessing. Our guide on speech delay versus autism explains other reasons for delayed talking.

05Multilingualism

Why multilingualism does not cause DLD

The NIDCD states clearly that learning more than one language does not cause DLD. DLD can affect both multilingual children and children who speak only one language. In a multilingual child, DLD affects all the languages the child speaks.

Importantly, the NIDCD explains that learning several languages is not harmful for a child with DLD, and a multilingual child with DLD will not struggle more than a child with DLD who speaks only one language. Families do not need to give up their home language. Parenting style does not cause DLD either: it is a neurodevelopmental condition, and in 50 to 70% of children with DLD at least one family member has the same difficulty.

06Assessment

Professional assessment and associated conditions

DLD is diagnosed by a speech and language therapist (speech-language pathologist). The NIDCD explains that the evaluation depends on the child’s age and the concerns raised, and generally includes direct observation, interviews and questionnaires completed by parents and teachers, assessment of learning ability and standardized language tests that compare the child with others of the same age.

DLD is not the same as autism or a learning disability, but it can coexist with other conditions. The NIDCD notes that DLD is a risk factor for learning disabilities, that some children with DLD show signs of dyslexia, and that dyslexia and autism are more common in their families. Each child’s profile is assessed individually. Our guide on signs of dyslexia covers reading difficulties.

07Therapy

Individual speech-language therapy

The NIDCD explains that treatment is typically provided or overseen by a speech-language pathologist and depends on the person’s age and needs. Identifying and treating DLD early is ideal, but people can benefit from treatment whenever it begins.

For young children, therapy can help them acquire missing elements of grammar, expand their understanding and use of words and develop social communication skills. For school-age children, it may focus on following directions, understanding the words teachers use, organizing information and improving speaking, reading and writing. Adults starting new jobs or studies may need help learning technical vocabulary or improving workplace writing.

08Home and school

Practical home and classroom adaptations

NLG explains that children with DLD may need speech and language therapy as well as support from parents and carers and within the classroom. With the right support, it says, children can go on to achieve their full potential.

The areas the NIDCD highlights for school-age children, such as following directions, understanding the words teachers use and organizing information, are good starting points for agreeing adaptations. The NIDCD also reminds adults that a child who does not follow instructions may not have understood them, rather than being stubborn. The specific strategies should be agreed with the child’s therapist and teachers, so that home and school use the same approach. The NIDCD notes that research is exploring how best to coach parents and peers to support language at home and school.

09Sources

Where the sources differ

The NIDCD page is detailed and covers all ages; the NLG page is a short summary for parents. Points of difference:

• Age at diagnosis. NLG says children diagnosed with DLD will be over 5. The NIDCD focuses on early identification and treatment from the preschool years. Both are compatible: concerns can be assessed and supported early, even if the formal diagnosis comes later.
• Other diagnoses. NLG says DLD is not explained by diagnoses such as autism or a learning difficulty. The NIDCD says it is not explained by hearing loss or autism and describes DLD as a risk factor for learning disabilities and dyslexia.
• Long-term outlook. The NIDCD explains that DLD persists into adulthood, changing with age, and that many adults develop strategies to manage it. NLG highlights the long-term impact on social and academic development and self-esteem.
• Figures. The NIDCD’s prevalence figure comes from US kindergarten data and should not be read as a local figure.

10Summary

In summary

Developmental language disorder is a common, persistent difficulty with understanding and using language that is not explained by hearing loss, autism or lack of exposure to language. It often starts with late talking and continues to affect vocabulary, grammar, understanding, reading and writing as children grow. It is not caused by parenting or bilingualism.

A speech and language therapist diagnoses DLD and plans therapy, which helps at any age. Coordination between family and school is key: a shared record with examples of what the child finds hard, the adaptations agreed and when they will be reviewed helps everyone support the child in the same way as communication demands change.