DLD – a deeper understanding with Dorothy Bishop
Developmental language disorder (DLD) is the new term to replace specific language impairment (SLI). Up to two children in every classroom of 30 has this condition, it is probably the most common childhood condition that you’ve never heard of. In light of DLD awareness day on the 22nd September 2017, we caught up with Dorothy Bishop, Professor of Developmental Neuropsychology at the University of Oxford, the brains behind the Raise Awareness of Developmental Language Delay (RADLD) Campaign, to find out why the ‘rebranding’ was necessary, and what happens next.
In case you didn’t know: What is DLD? Fact sheet
Why is it important to have a DLD Awareness Day?
“It goes back to when I first became aware that a lot of people have never heard of specific language impairment (SLI), which was the previous term for DLD. It really was a Cinderella subject in comparison with diagnoses like autism and dyslexia, in that most people had never heard of it and it had simply been neglected. Given that it affects as many children as dyslexia (on average, 2 in every classroom), we needed to do something about it.
“So we started what became the RALLI (Raising Awareness of Language and Learning Impairments) Campaign (which became RADLD) and on a shoestring started producing videos and informative material, but we kept coming up against the issue of what to call it. We had been using ‘specific language impairment’ but were getting a lot of kickback from other academics and researchers, who argued that “specific” part was not terribly meaningful. It wasn’t often that you would find children with a “specific” difficulty. In fact, more often than not, it’s accompanied by other things.
“So we conducted a consensus-building exercise which brought a group of experts together online, and in one part focused on the terminology we should use. This was by far the hardest topic to get agreement on. However, we eventually dropped SLI, and came to the conclusion that we should use the term Developmental Language Disorder (DLD).
“Then the question was how we were going to get the word out there. It was all well and good conducting the research study, but we had to make sure there was some impact in reality so the children could start getting the help they needed. So with the help of some incredible PR expertise we devised the DLD awareness day. To coincide with that, there was also a special issue of the Journal of Child Psychology and Psychiatry which Professor Courtenay Norbury had edited on the topic of language disorder in children. We decided the awareness day should really tie in with that.”
You can download the journal entry for free until the end of October.
What would be the ideal outcomes of DLD Day?
“Getting the consensus and awareness around the terminology is key. However it’s been through these discussions that I have come to realise just how bad the situation is in terms of children being denied services because they aren’t meeting some fairly arbitrary and not-very evidence based criteria. There are a lot of children who aren’t meeting stringent criteria for having a very specific problem and so are not getting any help at all. The way we have now defined DLD should make it clearer so that the decisions about who gets helped will be based on the severity of need. We think and hope it will result in a fairer deal for children, with better and more accurate diagnoses.
“We’re also hoping for an attitude change within the profession. We’ve found that with a lot of teachers and speech and language therapists (SLTs) working in early years, there’s a belief that there is little you could do to help older children with long-term and persistent difficulties. Whenever I hear that, I always think, ‘well you wouldn’t say that for autism.’ We should still do our best to support children to make sure they avoid adverse consequences, empowering them to make the best of what they’ve got.
“Sadly, there are many children who are getting a raw deal. We want more attention and continued support for children in primary school who are struggling as they have been missing out on support.
“One of the problems we need to overcome is that a lot of settings and practitioners have limited resources. We decided that we should not take ‘limited resources’ as a reason for not acknowledging and recognising the problem. The definition of DLD is that you have a child who does have problems that have functional impact in that they affect how they interact with other people, their educational progress and their life in general. We know the longer term outcomes are poorer for children with persistent language problems. We can’t simply say ‘you don’t exist’ because we don’t have resources. Rather, it would be better to identify the problems, highlight them and then make the case for getting the resources to work with them.”
What’s needed now to improve the provision for these children?
“The current situation is not good; we know that these children aren’t receiving enough support, however we don’t know enough yet about what would be the best provision. We are taking a proactive stance as this is an area which is hugely under-researched.
“I once did a comparison on how much research there had been on DLD (at the time SLI) versus attention deficit hyperactivity disorder (ADHD), which is similar in frequency and judged similarly in terms of impact on a child’s life. I found there was 19 times more research on ADHD. I think there could be many reasons as to why that is, but one of the barriers was that we didn’t have a clear label and definition of what we were talking about. So now there is consensus on DLD, then it should be easier to persuade people to support us and conduct more research.
“Hopefully now things can start moving in a more positive direction.”
Dorothy Bishop’s research is funded by the Wellcome Trust and focuses on the nature and causes of children’s communication problems — encompassing psychological, linguistic, neurological and genetic aspects. Her work has laid the foundation for the genetic investigation of developmental disorders. In particular, Dorothy pioneered the use of data from identical and fraternal twins to reveal the influence of genes on language disorders.