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In our guest blog this month, Amelia Wesley-Holley describes how the speech and language therapy service in Hackney have embraced the new Development Language Disorder term

DLD…Welcome to Hackney!

It’s been a long time coming but we finally have an agreed term for Specific Language Impairment (SLI)/ Language Learning Impairment/ Language Disorder (…the list goes on). I, for one, am keen to run with it! Thankfully, my colleagues in Hackney’s Children’s Integrated Speech and Language Therapy (SLT) Service feel the same.

The September release of the CATALISE paper (Bishop et al., 2016) was very timely for our team, as we had an internal ‘SLI assessment’ CPD slot booked only weeks later. Enthusiastically, we seized the opportunity to wholeheartedly adopt the new Developmental Language Disorder (DLD) term across the service.  This CPD session involved lots of team discussion on how this will impact our service and how it may change our practice. Being in the wonderfully dynamic and evidence driven team that I am, these discussions and changes took off quickly, with a united team proudly marching the term forward. We also prioritised spreading the change throughout the borough’s professionals. This included a multi-disciplinary meeting with key members of the local educational authority’s SEND team (Hackney Learning Trust), Educational Psychology and Assistant Head Teachers of the two Language Resourced Schools we have in Hackney. Similarly, we have had several discussions with our Specialist Teacher and Paediatrician colleagues to raise awareness, with further plans for more formal training across the borough.

Parents and families have, of course, been a significant focus for us in this movement too. We have developed some parent and professionals’ DLD information leaflets to aid the awareness. We are keen to share these and have made these widely accessible on our team website www.GetHackneyTalking.co.uk. We have also shared a parent focused DLD blog post written by one of our Service Managers, Stephen Parsons which can be viewed on the website here. Longer term projects we plan to focus on are DLD specific parent support groups and perhaps, even one day, a DLD diagnostic clinic.

I have encountered some resistance to the new DLD term through Twitter and CPD networks, relating to the specific terminology and connotations it may bring. While no term will ever be perfect, my view is that this is the consensus, achieved by a rigorous process. Therefore, we, as a profession, and families, as advocates and service users, will only benefit from a united movement forward, embracing the term for the benefit of increased awareness and access to appropriate support.

While the new and agreed ‘label’ is great, one of the best outcomes, for me, has been the overall raised profile and awareness of DLD. The increased hype, attention and energy the new term has given us must not be ignored, but capitalised on to give DLD the profile it needs and deserves. I have felt an increased attention and interest towards DLD within our own SLT team, regardless of wider professions, which is surely vital in its promotion and something to celebrate.

So this has been our journey in Hackney in the last six months. However, there is still much to be done. A key focus for us is working towards a service-wide clear set of DLD diagnostic criteria. Although this is supported by the recent research, particularly that of Bishop et al. (2016) and Norbury et al. (2016), I feel that this information needs a certain level of translation into everyday practice. A particular area we need to consider is whether the child/ young person has DLD or a Language Disorder associated with a Learning Difficulty. The research talks about a profile of DLD which includes children and young people with a low average IQ (>70). However, in my experience, IQ levels and ‘learning disability’ diagnoses are rarely given in practice, so how do we identify these children? A helpful approach could be to use more dynamic assessment. We could then aim to gauge the child’s learning potential and identify the types of prompts or scaffolding a young person benefits most from. While we can use the emerging developments of the DAPPLE (Hasson et al., 2013) and dynamic assessment (Camilleri et al., 2014), we need wider, more robust tools for dynamic assessment. Tools aimed at differentiating between children with transient or persisting language difficulties, and identifying their response to structured support would be particularly useful.

Furthermore, we need to develop our pathways and service offer for children and young people who do show a Language Disorder associated with a Learning Difficulty. Typically, these profiles are excluded from research and intervention trials, leaving few evidence based recommendations for how to best support this population. A further challenge for this group is that their profiles can vary greatly, adding to the complexity of a clear ‘service offer’. Nevertheless, in my experience, these children and young people are frequently known or referred to us as SLTs, so we must consider what they need as well as what this looks like and who is the best person to deliver support.

In summary, I have only seen benefits from this change in term and am keen to drive the movement for the better. Our service has responded rapidly to the changes, leading to increased promotion, awareness and attention, ultimately impacting positively on the children and families we support. So here’s a call for all services to do the same; let’s move together to create better outcomes for our families experiencing DLD!  

Amelia Wesley-Holley

Highly Specialist Speech and Language Therapist

Children’s Integrated Speech and Language Therapy for Hackney and the City

@ameliavwh

Bishop, D.V.M., Snowling, M.J., Thompson, P.A., Greenhalgh, T., CATALISE consortium (2016). CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children. PLoS ONE 11(7): e0158753. doi:10.1371/journal.pone.0158753
Camilleri, B., Hasson, N. & Dodd, B. (2014). Dynamic Assessment of bilingual children’s language at the point of referral. Educational & Child Psychology, 31(2), pp. 57-72.
Hasson, N., Camilleri, B., Jones, C., Smith, J. & Dodd, B. (2013). Discriminating Disorder from Difference Using Dynamic Assessment in Bilingual Children. Child Language and Therapy, 29, 57-75.

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, 2016.

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