What is Developmental Language Disorder?
Developmental Language Disorder (DLD) is probably the most common difficulty that most of us have never heard of, yet it is much more common than autism, and it affects about 7% of the population – on average that’s approximately 2 children in every classroom.
Children, young people and adults with DLD struggle with spoken language. Imagine you arrive in a foreign country where everyone talks to you and to each other in a language you do not know very well. You will pick out some words that you recognise, but it is really hard to follow instructions, or take part in conversation. Communication takes place so quickly that it is very hard for you to keep up and you might just ‘tune out’ as a result. This is how it feels to have a DLD.
People with DLD may also find it difficult to put their own thoughts into words to tell you what they are thinking or feeling. Many of them get the words muddled up or miss out parts of the sentence. We all find it hard to remember words at times – it’s that ‘tip of the tongue’ feeling you might get occasionally where you know you know the right word but you just can’t think what it is. Children with DLD can struggle to find words all of the time. Others get the sequence of sounds and syllables in long words muddled up – they might say ‘cer-fi-ti-cate’ instead of ‘certificate’, or ‘hop-si-tal’ instead of ‘hospital’.
The world can be a confusing and lonely place if you have DLD. It’s hard to make friends when you can’t keep up with every day conversation. Moreover if you are having trouble with spoken language, it is very likely that you will also find reading and writing problematic too.
Children and young people with DLD will not necessarily ‘grow out of it’. For many, it is a long term condition and can have a huge impact on their learning and achievement in school. It may lead to the child feeling frustrated, anxious and lacking in confidence.
In Gateshead, we have a dedicated team of speech and language therapists who routinely work with children and young people with DLD to help them and their parents cope. We see children in the most appropriate setting including their homes, in clinics and in schools. We are trying to increase awareness and understanding of DLD so that families and teachers know how to help. We also offer therapy to boost the child’s language skills, improve their communication, promote independence and raise self-esteem.
Key Word Levels:
You may have heard one of our therapists, or another professional talk about following ‘key word level’ instructions. ‘Key words’ or ‘Information-carrying words’ refers to the number of words in an instruction that the child needs to understand to be able to follow it.
For example, ‘put the shoe on the table’ requires your child to understand that you mean ‘shoe’ and not ‘sock’ or ‘coat’. They also need to be able to understand that you mean ‘on’ rather than ‘under’ or ‘behind’, and they need to be able to understand that you mean ‘table’ rather than ‘chair’ or ‘bed’. This instruction would therefore be an example of a 3 key word level instruction, as it contains 3 key words.
A key word must have another option for it to be a key word. For example, ‘table’ is not a key word if you only have a table in front of you, and don’t have a ‘chair’ or a ‘bucket’, or something else they could use instead, because it doesn’t show that they understand ‘table’- it’s the only option in front of them.
As a general rule, we expect children to be able to follow as many key word levels in their instructions as their age, e.g. a 3-year-old should be able to follow 3 key word level instructions.
Word Finding:
Word finding, also called “word retrieval”, is a person’s ability to think of the right word when they need it, during conversation. This may cause them to have pauses, use filler words like “um” and “like”, or use non-specific words like “that thing” or “that stuff”. This is similar to when it feels like a word is just on the ‘tip of your tongue’. There are lots of strategies that can be used to support children with word finding difficulties:
- Use word webs. Word webs can be used for words that are completely new, or words that your child has struggled to recall. Word webs help to solidify those words into your head, making them easier to recall later.
- Practice describing words. The way that word finding difficulties work is that the child will often be familiar with the word, and what it means, but struggle to remember the word itself. Therefore, instead of saying the word, you could describe what it means instead, for the other person/people in the conversation and they will understand what you’re trying to say.
- Give other clues such as the first letter, the number of syllables, whether it’s a short or a long word, rhyming words, similar words or synonyms etc.
- They may also benefit from being told the topics that are coming up at school, so that he can pre-learn some core vocabulary using word webs or using a mind map.
- They will also benefit from having more visual support available. Children with word finding difficulties often find it easier to recall words when they can see a picture of the object or concept.
Natural Language Acquisition or Gestalt Language Processing:
Every child is different, and therefore the way that children learn language may differ from one to the next. However, broadly speaking, there are two main ways that children acquire language, and these are called ‘Analytical Language Development’ and ‘Natural Language Acquisition’.
- Analytical Language Development follows a bottom-up approach, where children learn single words, and then start to put those single words together to form short phrases, which then develop into full sentences.
- Natural Language Acquisition follows a top-down approach, where children may start learning language in chunks or set phrases, rather than learning single words first. These chunks of language can be called ‘scripts’ or sometimes are known as ‘gestalts’. Children who follow this pattern of language development are sometimes called ‘gestalt language processors’.
Key Points about Gestalt Language Processing:
- Repeating Language (Echolalia)
Children might echo back what they hear right away (immediate echolalia) or after a delay (delayed echolalia), using these gestalts as a way to communicate. This is a natural part of their language development. It is common for these children to echo language they have heard at home, in school, on TV, or on YouTube. They typically echo language that was highly emotive, such as an exciting line from a TV show. They also often replicate the intonation (rise and fall of voice) or accent of the person or character. - Intonation
Children who learn language in this way are often drawn to the rich intonation (up and down musical tones) of songs, TV shows, and YouTube, associating these gestalts with strong emotions. Songs tend to capture their attention, and they often sing a wide range of songs or mimic their melodies and intonations. These children may sing these songs throughout the day, such as during playtime. However, sometimes they may only repeat the intonation they hear. This may sound like babble or strings of sounds that can be difficult to interpret. - Understanding Language
Initially, these children may assign a general feeling or meaning to the whole phrase or gestalt rather than understanding each individual word. Over time, they begin to break these chunks into smaller parts, enabling them to understand and use language more flexibly. They may repeat these gestalts (delayed echolalia), reflecting the feelings or meanings they originally connected to the experience.
Strategies – Responding to Your Child
- Respond to what your child has said positively, even if it is not completely clear. Nod, smile, make affirming sounds like “uh huh!”
- Repeat back the phrase, word, song, or sound that your child has used. Match and exaggerate their intonation as much as possible.
Strategies – Being a Detective
- Keep track of the gestalts (phrases) your child uses by writing them down exactly as they say them.
- It is useful to take note of the context the child used the gestalt
- This is useful in finding out the meaning behind the gestalt (phrase) and were it may have come from e.g. an episode of Peppa Pig.
Strategies – Making Comments
- Try to reduce your questions
- Change your questions into comments, for example, you can turn “what’s that?” or “what have you got there?” into “you’ve got a car!”.
- You can comment on what your child is looking at e.g. “it’s a blue car!” or doing “I’m jumping”
Strategies – Using Music and Intonation
- When commenting, try to make your voice sound exciting with exaggerated intonation.
- Sing songs related to the activity you are doing with your child. For example, sing “Clean Up, Clean Up” during tidying up or “This is the Way We Wash Our Hands” during handwashing.
- Give opportunities for your child to finish the last word, line or verse of familiar songs