what is dld: heterogeneity in developmental language ... · catalise 1: criteria for identification...
Post on 07-Feb-2019
244 Views
Preview:
TRANSCRIPT
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?
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
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
Examples of Statements 2
• 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
Examples of Statements 3
• 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
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
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
CATALISE Phase 2: Terminology
31
Examples of Statements 4
• 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
Examples of Statements 5
• 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/
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
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
top related