Developmental language disorder: a guide for parents

A four year old tells a story at home in loose words, while peers already string sentences together. Or a seven year old understands a class instruction only when a classmate shows it. Parents then search for developmental language disorder, often shortened to DLD.

A developmental language disorder is a lasting difficulty with understanding language, using language, or both. This article explains the term, the difference from a speech disorder, and signs parents meet, including when a child is late to start or talks little.

It does not diagnose. LogiLand is practice software for playful exercises. It does not replace a speech therapist. Practise at home only if the clinician advises it.

Speech and pronunciation sit apart in speech disorder. A child who is silent in one place and talks in another is covered in selective mutism.

What a Developmental Language Disorder Is

Language is more than loose sounds. It covers knowing words, building sentences, following a story and explaining something yourself. In a developmental language disorder that development stays clearly behind, and a short wait does not close the gap.

Internationally the same picture is called developmental language disorder, shortened to DLD. A broad expert panel agreed to use that term when the language problems are substantial and persistent, and no other medical condition covers the picture on its own, such as a hearing loss that fully explains the language (Bishop et al., 2017). Where a clear additional condition is present, clinicians describe the language difficulty together with that condition. The Dutch term taalontwikkelingsstoornis (TOS) follows that agreement.

How common is it? In a population study of English preschoolers, about 7.6 percent had a language disorder in the DLD sense (Norbury et al., 2016). An earlier American study of kindergarten children found about 7 percent (Tomblin et al., 1997).

The order of magnitude is about seven in a hundred children. DLD is a familiar reason for speech therapy. It shows up often enough that clinics know the picture well.

DLD says nothing about intelligence. Children with DLD think, play and learn in many areas. Language is where the extra work sits. You see that work at school, because instruction, friends and later reading lean on language.

DLD and a Speech Disorder

Parents also type "speech disorder in a child". Speech and language sit next to each other and sometimes run together. They stay two layers.

Speech is the sounds you hear: whether a word is intelligible. A speech disorder sits in pronunciation, for example a sound that drops out or is replaced.

Language is meaning and sentence structure. A child can pronounce clearly and still make short, unclear sentences. Another child speaks unclearly and builds sentences with difficulty. Speech and DLD can then occur together.

A speech therapist separates those layers. At home you can keep examples: a sentence your child said, and what you think they meant. That helps the first conversation. Those notes are not a test.

Articulation on its own, such as an /s/ or /r/ that still sounds different, is a speech question. The S exercises for a lisp and the R exercises are the entry for that, always beside a clinician's judgement.

Signs Parents Often See

A list of signs does not establish DLD. Parents do recognise pieces of this picture:

Young children

• First words come late, or stay loose words for a long time
• Sentences stay short while peers already give reasons and little stories
• The child points or pulls you along, because the sentence does not come
• Questions such as "where is your shoe?" land only after a gesture

In primary school

• Instructions with several steps fall apart
• The child hunts for words ("thingy", "that there")
• Retelling a book gets tangled: order, and who did what, get lost
• New school words do not stick

In contact

• Conversations with unfamiliar people run stiffly
• The child avoids talking, or gets angry when people do not understand
• Other children talk for them

One sign can belong to ordinary variation. A stack of signs, across months, is a reason to have it checked. Hearing belongs in that conversation. A child who misses sounds or sentences because they do not hear them needs a hearing check first.

Delayed Speech and a Child Who Talks Little

"Delayed speech development" and "my child does not talk" are narrow search questions that often land here. They cover different situations.

Some children are late talkers. Around age two they still say few words, and some of them catch up in language later. Others keep a language difficulty.

Waiting until school age is a costly gamble when the gap is large and understanding also looks weak. A speech therapist can judge whether extra support fits.

A child who talks almost nowhere needs a wider look. Look at hearing, at contact, and at whether the child does talk at home. If they speak in sentences at home and stay silent only at school or with strangers, the picture fits selective mutism more closely. That is an anxiety question, and the approach differs from DLD.

A child who also uses hardly any language at home belongs in the conversation about language development.

Age sketches, without a diagnosis, are at age 2, age 3 and age 4.

What a Speech Therapist Looks At

The speech therapist maps understanding, vocabulary, sentence building and story structure, and looks at speech and hearing. Sometimes a doctor, an audiology centre or a behavioural specialist joins in. The DLD diagnosis is a clinical judgement.

Parents supply the examples. The clinician sets the label.

Treatment aims at the language the child needs now: longer utterances, words that come back at school, understanding an instruction. Parents sometimes receive a concrete role, for example a way of reading aloud or a question that invites a longer sentence. That role comes from the clinician, fitted to this child.

Without that advice, a protocol from the internet is a guess. An exercise written for pronunciation misses a language problem. An app that asks a child to repeat words does not assess language.

At Home, on the Clinician's Advice

If the speech therapist advises practice at home, keep the moments short and fold them into something you already do.

Reading aloud with a pause. Read a page, point at a picture and wait. The pause leaves room for a word or a short sentence. Then expand with a sentence a little longer than the one your child said.

One new word in a real sentence. "The spoon is in the drawer." Repeat that word later in the day in a new sentence. Loose cards without a situation stick less well.

A short turn in a game. Only if the clinician has given a speaking task. LogiLand is then extra practice software beside the session. It does not treat DLD.

Stop when there is resistance. Crying or refusing is a signal to shorten the moment and to stop pushing. Mention it at the next appointment.

If the clinician has not asked for anything yet, stay with ordinary talk, reading aloud and play. That is time full of language. It is not a therapy protocol.

When to Seek Help

Contact the child health clinic (in the Netherlands, the consultatiebureau), your GP or a speech therapist if:

• your child clearly understands less, or says less, than peers, and that continues for months
• sentences stay away while the child joins in socially
• school reports that instruction does not land
• speech is so unclear that family members have to guess as well
• you are unsure among "late to talk", DLD and silence at school

An early explanation shortens the period in which a child has to guess at language. A clinician gives that explanation. LogiLand does not.

Conclusion

A developmental language disorder is a language difficulty that calls for targeted help, in about seven in a hundred children (Norbury et al., 2016). You see the examples at home. The speech therapist weighs whether it is DLD, a speech question, or something else.

Read on: speech disorder, selective mutism, phonological awareness and speech therapy exercises at home.

This article explains DLD for parents. It does not diagnose. Practise at home only if the clinician advises it. LogiLand is practice software and does not replace a speech therapist.

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Frequently Asked Questions

What is a developmental language disorder? A lasting difficulty with understanding language, using language, or both. The international term is developmental language disorder (DLD). In Dutch the name is taalontwikkelingsstoornis (TOS), used beside the full name.

Is DLD the same as a speech disorder? No. A speech disorder sits in pronunciation. DLD sits in words, sentences and understanding. They can occur together. A speech therapist separates them.

My child talks late. Is that DLD? It does not have to be. Some late talkers catch up. If language stays clearly behind for months, or understanding is weak as well, have it checked. Waiting until groep 3 is a poor plan when the gap is large.

My child talks at home and stays silent at school. Is that DLD? That picture fits selective mutism more closely, a form of anxiety. Let a clinician make the distinction. Pressure to talk at school makes that anxiety worse.

May I practise language with an app? Only if the speech therapist advises it, and only as an addition to the sessions. LogiLand is practice software. It does not assess DLD, and it does not replace treatment.

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References

Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & the CATALISE-2 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://doi.org/10.1111/jcpp.12721

Norbury, C. F., Gooch, D., Wray, C., Baird, G., Charman, T., Simonoff, E., Vamvakas, G., & Pickles, A. (2016). The impact of nonverbal ability on prevalence and clinical presentation of language disorder: Evidence from a population study. Journal of Child Psychology and Psychiatry, 57(11), 1247-1257. https://doi.org/10.1111/jcpp.12573

Tomblin, J. B., Records, N. L., Buckwalter, P., Zhang, X., Smith, E., & O'Brien, M. (1997). Prevalence of specific language impairment in kindergarten children. Journal of Speech, Language, and Hearing Research, 40(6), 1245-1260. https://doi.org/10.1044/jslhr.4006.1245