Developmental language disorder …

Ryan W Y Lee MD

Neurobehavioral & Cognitive Disorders

Updated 04.29.2024
Released 01.06.1995
Expires For CME 04.29.2027

Developmental language disorder

Author: Ryan W Y Lee MD

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Editor: Ann Tilton MD

Developmental language disorder

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Introduction

Overview

Developmental language delays and language disorders are a relatively common developmental finding in children. A review of the literature indicates a persistence of language delays in a percentage of children. Language disorders may persist across the lifespan, and symptoms may change over time. The lack of consistency in the terminology and classification systems related to developmental language disorders impacts research and clinical practice.

Key points

	• Developmental language disorders are not uncommon, and they have some long-term impacts on the lives of the individuals.
	• A language disorder may occur in the presence of other conditions such as hearing impairment, intellectual disabilities, developmental disabilities, autism spectrum disorder, attention deficit hyperactivity disorder, traumatic brain injury, or psychological/emotional disorders.
	• No clear etiology has been found for developmental language disorders, but there is much interest in finding a gene or genes that affect language development. Multifactorial etiology, clinical heterogeneity, and differential diagnosis of primary and secondary language disorders make management more complex.

Historical note and terminology

Developmental language disorders have been examined in the literature for some time, but no consistent definition or classification system has been used across studies. Developmental language disorders are distinguished from other conditions by a language deficit resulting in problems with comprehension, production, or language usage. When a language disorder is the primary disability with no comorbidities such as sensory impairment, intellectual disability, global developmental delay, motor dysfunction, autism spectrum disorder, or attention deficit hyperactivity disorder, it is considered a developmental language disorder.

One classification of communication disorders was based on clinical, functional, or anatomical features and associated findings. One category in this classification, developmental speech disorder syndrome, included a wide variety of disorders ranging from mild delays in articulation and language development to severe comprehension difficulties and lack of speech development. No further differentiation was made, and this was a diagnosis of exclusion (60).

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders classified developmental language disorders as communication disorders and included the categories of expressive language disorder, mixed receptive-expressive language disorder, phonological disorder (formerly developmental articulation disorder), and communication disorder not otherwise specified (03). Each of these disorders must interfere with academic or occupational achievement or with social communication. Expressive language disorder and mixed receptive-expressive language disorder were defined by a discrepancy between nonverbal intelligence and language abilities. Communication disorders may coexist with mental retardation, speech-motor or sensory deficit, or environmental deprivation, but the difficulties are in excess of those usually associated with these problems.

Although attempts to classify preschool language disorders have focused on the global nature of the disordered language (receptive, expressive, mixed), other attempts to classify developmental language disorders have focused on the nature of the spoken language deficit (102; 101). Further subgroupings include phonologic-syntactic disorders that display both phonologic disturbances (omissions, substitutions, and distortions of consonants and consonant clusters in speech) and syntactic impairment evidenced by lack of small words and absence of word endings. Oromotor dysfunction may be seen in these disorders, whereas comprehension, semantics, pragmatics, and prosody are relatively spared. Verbal auditory agnosia is characterized by an absence of auditory comprehension and little or no expressive speech. Patients with semantic-pragmatic disorders are fluent but are impaired in comprehension and show deficits in using the rules that govern the use of language in social contexts. The lexical-syntactic syndrome is marked by poor syntactic skills and difficulty finding words. Paraphasia is seen, but pragmatics, phonology, and comprehension are relatively spared.

The DSM-V (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) has moved back to a broader categorization of communication disorders (04). The category of communication disorders includes language disorder, speech sound disorder, childhood-onset fluency disorder (stuttering), social (pragmatic) communication disorder, and other specified and unspecified communication disorders. The unspecified diagnostic code is appropriate when further evaluation is needed (04). Speech includes articulation, fluency, voice, and resonance quality. Language includes the form, function, and use of a conventional system of symbols in a rule-governed manner for communication. The subcategory of language disorders now includes significant delays or functional difficulties in either expressive or receptive language for various forms of communication, including, but not limited to, written and spoken communication. Social (pragmatic) communication disorder addresses difficulty using language appropriately in a social context. DSM-5 criteria for communication disorders do not require a minimum level of nonverbal cognitive ability (86).

International standard diagnostic classification codes from the World Health Organization’s (WHO) International Classification of Diseases, Tenth Revision (ICD-10) are used to identify diagnosis and health conditions, including specific speech and language disorders, in public health and health care settings. Public schools in the United States do not use the ICD for diagnosis. Students are identified and qualified for special education services by the Individuals with Disabilities Education Act of 2004 (IDEA) (149). Fifty-three percent of speech-language pathologists in the United States are employed in schools, and 90% of speech-language pathologists working in schools serve children with language disorder diagnoses.

Clinical manifestations

Presentation and course

The identification of speech, language, and communication problems is a primary focus in the surveillance of overall child development. Expressive language delays are found in 13.5% of 18- to 23-month-olds and in 17.5% of children 30 to 36 months of age (78). In the United Kingdom, the median prevalence of combined receptive and expressive language delay/disorder in children seven years and younger ranged from 2% to 3% (71). The prevalence of specific language impairment for kindergarteners in the upper Midwestern region of the United States was 7.4% overall (136). The variability in prevalence estimates of language disorders is attributed to differences in how language impairment is defined, the nature of the population studied, and variations in the methodological procedures used (71; 95). Developmental language disorders are recognized at various ages because of the failure of the child to meet appropriate milestones or because of associated dysfunctions. There are many different definitions of significant language delay. It has been suggested that toddlers between 24 and 30 months of age who have fewer than 50 words and no word combinations are considered to have a delay (89).

Indicators of atypical development in speech, language, or communication identified based on consensus view of clinicians rather than empirically validated criteria (23) are intended to alert those working with children to the range of ways in which language difficulties can manifest.

	Age level	Indicators for atypical development
	Between 1 and 2 years of age	No babbling, not responding to speech or sounds, minimal or no attempts to communicate
	Between 2 and 3 years of age	Minimal interactions, does not display intention to communicate, no words, minimal reaction to spoken language, regression or stalling of language development
	Between 3 and 4 years of age	At most, two-word utterances, child does not understand simple commands, close relatives cannot understand much of child’s speech
	Between 4 and 5 years of age	Inconsistent or abnormal interaction, at most three-word utterances, poor understanding of spoken language, strangers cannot understand much of child’s speech, close relatives cannot understand more than half of what child says
	From 5 years of age and upwards	Difficulty telling or retelling a coherent story (producing narrative), difficulty understanding what is read or listened to, marked difficulty in following or remembering spoken instructions, talking a lot but very poor at engaging in reciprocal conversation, many instances of over-literal interpretation, missing the point of what was meant
(23)

Preschool children may show any of the earlier dysfunctions but more commonly present with poor phonology, difficulty with connected language that is misinterpreted as inattention, and poor interactive play skills. School-aged children present with academic underachievement, limited inferential thinking manifested as poor judgment, or limited pragmatic skills leading to difficulties in socialization. Of elementary school-aged children with persistent articulation difficulties, 11% to 15% also have a language disorder (112).

Signs and symptoms of language disorders vary across individuals depending on the language domain affected, severity and level of disruption to communication, age of the individual, and stage of linguistic development. Skills across the domains of form (phonology, syntax, and morphology), function (semantics), and use (pragmatics) must be considered in relation to each other. Children with language disorders may experience social-emotional problems or exhibit behaviors secondary to language impairment or both. These difficulties may impact self-perception and awareness, academic performance, peer relationships, and social interactions. Preschool children with developmental language delays tend to have more behavior issues, including social-emotional problems and withdrawal (132). Behavioral difficulties may persist into adulthood (58). Among Canadian children aged 7 to 14 years with psychiatric disorders, 40% were found to have a language impairment (35). In the northeastern region of the United States, 40% to 50% of children and adolescent speakers of Spanish and English referred for psychiatric services were found to have a language impairment following testing in both languages (138). Forty-seven percent of young people in custody demonstrated language skills significantly below the population average, and only 25% of those identified with an impairment had previously accessed speech/language services (59). A percentage of children will improve over time, but the remainder will show persistent residual difficulties (09), with about 27% showing ongoing language difficulties and weaker reading or social skills by school age (53). Stability in language across the first few years of school indicated that children with varying degrees of language impairment and co-occurring developmental concerns showed steady growth but did not narrow the gap between typically developing peers (87). Language disorder is associated with the persistence of hyperactivity in preschool children (92). Children with phonologic-syntactic language disorders do not have unusual handedness but demonstrate significantly poorer tapping and pegboard skills on computer-based testing (99). They also are more likely to exhibit other subtle neurologic findings in addition to fine motor differences (140). Developmental language disorders are associated with lasting academic underachievement (08; 62). The various associated findings are more prevalent in the receptive language disorders and mixed receptive and expressive language disorders (13; 14; 55). Individuals with developmental language disorder exhibit longer response times across verbal and nonverbal tasks, which may contribute to difficulties in language, motor skills, and executive functioning (156).

Prognosis and complications

Children with developmental language disorders exhibit a wide spectrum of outcomes. About half of the children with the expressive type of language disorder eventually acquire normal language skills; many of those with the mixed type also show resolution (03), but ongoing difficulties in academic, language, and cognitive tasks are more commonly found in children with mixed language disorder (14) or a nonspecific language disorder (137). Students in primary and secondary school with developmental language disorder demonstrate difficulties across all areas of curriculum compared to their typically developing peers (159). These children show an increased incidence of lower early reading skills, especially in the area of phonological awareness (44). In a large study of kindergarteners and first graders in Virginia, about a quarter of the children getting speech/language services required reading help, which was about twice the rate of their non-speech/language-impaired classmates (54). Even if not getting extra reading help, they were more likely to have lower-than-average reading scores. Reading difficulties may be as high as 50% or more in children with language delays, and there is some correlation between the severity of the language delay and reading skills (31). Children with ongoing language disorder seem to have more difficulty with reading fluency, at least through the third grade (100). General delays in reading have been shown to continue through at least the fifth grade (118), and despite making gains in reading skills, they are more likely to remain behind their peers into their mid-teenage years (122). These children also generally tend to have lower literacy skills as adults (74).

Along with the reading delays, those with early language delays tend to have lower IQ scores, behavior problems, and difficulties with writing or written expression (115; 21; 151). One birth cohort study in Minnesota showed increased incidence of written language disorder in those with speech and language impairment (127). Even a transitory language delay is related to a higher incidence of subsequent low IQ or reading problems (114). Children with continued significant delays at school entry tend to show ongoing deficits in many areas of communication, whereas children whose language delay has essentially resolved by this point often show milder delays in learning (129). The academic underachievement may be lasting (08; 154). There is wide variability in child language profiles over development, with evidence to suggest that differing child, family, and societal factors are associated with the differences in language development and responses to intervention. Low birth weight, socioemotional and behavioral problems, and lower family literacy were associated with poorer outcomes. By age 4, most children identified with language delays will continue to exhibit difficulties at age 11 (79). As adults, they may be more likely to hold lower-skilled jobs than their non-language-impaired siblings (47; 34) or their peers (62). In a longitudinal study following a cohort until 35 years of age, the individuals with language disorders had an increased risk of being unemployed for longer periods (74).

In addition to requiring more academic resources, children with early language delays also demonstrate deficiencies in developing social competence (05; 35b; 53; 120), with the social difficulties increasing into adolescence (123) and persisting into adulthood (34). Language disorder is associated with the persistence of hyperactivity in preschool children (92). Anxiety disorders (15; 145), attention deficit disorders, and behavioral disorders are increased in children with developmental language disorders (30). Not only are these disorders increased, but the association continues regardless of improvement in language skills (10). Behavioral difficulties may persist into adulthood (58; 26). Youth with developmental language disorder have poorer mental health than those without developmental language disorder, and there may be a genetic risk that manifests mental health disorders more strongly (139).

Predicting dyslexia in children with developmental language disorder is an area of interest. Alonzo and colleagues reported letter identification was the only significant, unique kindergarten predictor of dyslexia in second-grade children with developmental language disorder, when compared to phonological awareness (02).

Clinical vignette

Although fictitious, the following scenario might be considered typical. A 7-year-old boy struggled in first grade with poor grades in reading. He was inattentive and distractible at times. He first came to medical attention at 2 years of age, when he was not speaking. He seemed to understand what was said and was interactive with good eye contact. Motor milestones were achieved on time. Audiological testing was within normal limits. The physical and neurologic examinations were normal. Speech, language, developmental, and psychological (cognitive) evaluations at that time indicated expressive language skills at a 12-month level (developmental quotient = 50) and receptive language skills at an 18-month level (developmental quotient = 75) with average nonlanguage skills. By the time he reached school age, his language skills had improved, although not quite to typical age levels. Remarkable family history included a paternal uncle and cousin who were late to start talking and an older brother with a learning disability.

Biological basis

Etiology and pathogenesis

Developmental language disorders are a heterogeneous group of disorders and, therefore, unlikely to have a single etiology, although there is increased evidence of a heritable or genetic component. They also have polygenic associations that overlap with ADHD, educational literacy, and language (141). Developmental language disorders have been reported in children with diverse conditions including, but not limited to, circulatory arrest during surgery for congenital heart defects (16), resistance to thyroid hormone (27), chromosomal abnormalities such as sex chromosome abnormalities (18) or 22q11.2 deletion (121), prematurity (48), low birth weight (111) particularly when associated with bronchopulmonary dysplasia and patent ductus arteriosus (117), required stay in the neonatal intensive care unit at any gestational age (61), craniosynostosis and deformational posterior plagiocephaly (64), and lead poisoning (17). Other studies found no specific perinatal causes but did question an association with maternal toxemia (20). Language delays or disordered language can also be seen in hearing impairment, autism, mental retardation, or elective mutism. A loss of language skills occurring after a period of normal development can be seen in certain seizure disorders such as Landau-Kleffner syndrome, stroke, head injury, infections such as symptomatic HIV (152), or neurodegenerative disorders. Recurrent otitis media as a cause of developmental language disorder is still controversial; some studies have found a link (19), whereas others refute a direct connection (56).

Genetics. Numerous reports have indicated a heritable component to developmental language disorders. Language-delayed children are more likely than normal to have a history of language or learning disabilities in first-degree relatives (131; 11; 67; 76; 84). Tomblin found 23% of language-impaired children had positive family histories compared to only 3% of normals, with brothers at greatest risk (133). Twin studies also indicate a strong inheritance of language disorders, especially for expressive language and articulation (44). A high concordance rate was found for language disorder in monozygotic twins, often with a similar pattern of disorder (22; 134) and with the strongest concordance rates in the most severely affected twin pairs (143). Children with congenital adrenal hyperplasia were found to have an increased family history of language disorders, prompting the speculation of an association with the gene for this disorder (97). Research involving chromosome 7q and a possible relationship to a specific type of speech and language impairment in one extended kindred, the KE family, shows some positive results on a limited scale (146), especially the SPCH region of 7q31 (68) with a mutation at the FOXP2 gene (69). A different point mutation in FOXP2 has been found in another family with dyspraxia (77), and another case report describes a patient with significant dyspraxia along with other dysmorphisms who has a larger deletion on chromosome 7, including the FOXP2 region (157). Tomblin and his group evaluated a mother and daughter with a chromosome 7 and 13 translocation affecting this region of chromosome 7; both have a speech and language disorder similar to that of the KE family (135). Another case report described an individual with speech apraxia and mosaic deletion of 7q31, including FOXP2 (93). A Chinese study also found FOXP2 associated with speech disorders in their study population (158). FOXP2 mutations have not been found in other types of common language disorders (80; 85), although one study did find a link to two markers near the FOXP2 gene (88). Researchers are now postulating that the FOXP2 gene may play a regulatory role, affecting other genes on chromosome 7. One gene that might be affected by FOXP2 is the CNTNAP2 gene, which may be related to language disorders (142) and weaker language development in the general population in Australia (150). Linkage studies in a specific Chilean population with a heterogeneous language disorder showed the most consistent linkage to chromosome 7 in an area containing the FOXP2 and CNTNAP2 genes (144). This study also indicated less consistent associations to several other chromosomes, specifically chromosomes 6, 12, 13, and 17. Other chromosomes are also being studied as possible loci for language disorders, including chromosomes 15q (25), 13q21 (07), and 16q (119). FOXP1 intellectual disability syndrome is also being described as a recognizable entity (81). The ZNF385D gene on chromosome 3 may be another regulatory or transcriptional gene for both language impairment and reading disorder (46). Most likely, no one specific chromosome or gene defect will explain all developmental language disorders but several areas on the genome may contribute to language development. Neurodevelopmental disability, in the form of global developmental and cognitive delay with and without seizures, was found in all patients with de novo KCNB1 missense variants in the ion channel domain and loss-of-function variants in this domain and the C-terminal (43). A genome-wide association and exome sequencing study concluded that developmental language delay is best conceptualized as etiologically complex, with several candidate genes, including SETBP1 and MEF2-regulated pathways identified (63). Genome-wide association studies have identified dyslexia-associated variants (52).

Pathophysiology. The pathophysiology of language disorders in the developing brain of a child has not yet been fully defined. Studies have shown a progression of changes on event-related brain potentials in normal maturation of language skills. In some late-talking children, there is a delay in this progression, and some children with language impairment have atypical organization in the patterns of activity (83) or show difficulty with specific auditory processing (90). One study showed a higher percentage of children with language disorder, most without a history of seizures, had paroxysmal abnormalities on EEG when compared to controls (94). Specific brain lesions have not been associated with developmental language disorders in children. Even left-hemisphere lesions do not fully account for the findings of developmental language disorders (06) with indications of plasticity or recruitment of the right hemisphere in early development (75). Children with developmental language disorders are, however, more likely than controls to have findings on MRI (140). In a study of 41 adults with developmental language disorder, an extra sulcus was noted in the inferior frontal gyrus that was associated with a behaviorally based classification but not a positive family history (33). MRI volumetric studies indicate atypical perisylvian asymmetries, reversed asymmetry or lack of asymmetry (96), and generally decreased volume of the Caudate Nucleus bilaterally (147). These MRI findings of perisylvian asymmetries are present in some first-degree relatives, but this is not a firm association (96). A SPECT study also found a lack of asymmetry of cerebral blood flow when compared to controls with ADHD (91). Similar findings of asymmetry are also noted on event-related brain potentials (83). Brainstem auditory evoked potentials show lower latencies in language disability but no significant difference from normal in the central conduction time of the auditory pathway (I-V interval) (107). Researchers are attempting to describe the functional neuroanatomy of letter-speech sound integration in relation to brain abnormalities in patients with developmental dyslexia (104). Yet various researchers have found that some of these children have difficulties with temporal sound stimuli in the rapid pace of typical conversation, which is thought to affect language-based learning and, potentially, language skills themselves. This deficit is theorized to be localized in the auditory arm of the language pathway (66), and early work is showing improvement in these deficits with repetitive training (82; 130). One study, using event-related brain potentials, looked at younger children (ages three to eight years) and found a similar delay in neuronal recovery when auditory stimuli were presented more rapidly. This was localized in the left hemisphere when “linguistic probes” were used and the right hemisphere when “nonlinguistic probes” were used (125). Auditory feedback plays a key role in speech-motor control. Developmental language disorder makes atypical use of auditory feedback (42).

Studies show deficits in memory learning in adults with developmental language disorder. In procedural memory, adults with developmental language disorder demonstrate a learning deficit relative to adults without developmental language disorder but appear to have comparable retention of learned information (45). In declarative memory, adults with developmental language disorder demonstrate a deficit in the overnight enhancement of memory retrieval, despite typical-like learning exhibited when tested shortly after encoding.

Children with developmental language disorder have atypical brain volume, laterality, and activation or connectivity patterns in key language regions that likely contribute to language difficulties (01).

Epidemiology

The prevalence of developmental language disorders varies widely. Estimates in preschool children range from 4% (51) to 19% (12). This is due, in part, to differing definitions of the disorder, differing methods of ascertainment, and population differences. Studies indicate a prevalence of 6.9% (28), 7.4% (136), and 4% to 7% (148). Most studies report a larger proportion of affected males (126; 113), with a ratio of about 2:1 (51; 28), although the Tomblin study noted an almost equal prevalence in the sexes (136). School-aged children on the Isle of Wight have a prevalence of language delay of 0.8 in 1000 (108).

Language delays can persist, especially in children with difficulty in receptive language or comprehension, and even more so in boys and in those with a family history of language impairment (57; 155). Many preschool children with developmental language disorders do show improvement in their language abilities by seven years of age. Despite the improvement in language, 42% show residual difficulties such as low IQ or reading problems (114). Some studies note a drop in overall IQ scores around the preteen years (24), which was not substantiated on one long-term follow-up into adulthood (34). Continued academic underachievement is noted even in those children who are managing in their coursework (124; 35). As adolescents, language-delayed individuals function less well and less independently on daily living skills than their typically developing peers (40). Behavioral problems are also more prevalent (115). Other studies have found residual social difficulties (05; 38; 41), including an increased risk of being socially victimized (39) and psychiatric disorders (30; 37; 36; 145).

There is some evidence that mobile device screen time of 1 hour or more per day is associated with poorer language development among toddlers (103).

Diagnostic workup

Universal screening tools for language and behavior concerns in preschool-aged children in community settings can demonstrate excellent predictive validity (116). Pediatricians identify speech-language delays at similar rates as the national prevalence of 15%, and most are identified at the 18- or 24-month well-child visit (49). Incorporating these tools into routine child health surveillance could improve the rate of early identification of language and behavioral difficulties, enabling more informed referrals to specialist services and facilitating access to early intervention (116). Developmental language disorders are diagnosed only after other diagnoses, such as hearing loss and autism spectrum disorder, have been excluded. Workups are often done in conjunction with a speech and language pathologist, after suspicion is raised in the primary care provider’s office on history or general developmental screening. Individuals suspected of having a developmental language disorder should be referred for a comprehensive, linguistically appropriate assessment by a speech/language pathologist. Assessment of language skills should be culturally relevant and functional and include input from families/caregivers. The assessment should include a relevant case history, hearing screening, oral mechanism examination, and formal evaluation of spoken language skills, including phonology, semantics, morphology, syntax, and pragmatics. Assessment of speech sound production or augmentative and alternative communication strategies may also be indicated depending on the nature and severity of the deficits and the child’s developmental history. Data may be collected through standardized assessment, language sampling, observation, parent interview, checklists or questionnaires, or curriculum-based assessment. Aspects of language impairment that are relatively uninfluenced by social and cultural background, such as nonword repetition, sentence repetition, and production of grammatical inflections marking verb tense, identify children with language impairments whose main difficulties are with language form rather than content or use (23). Broad-ranging IQ tests, such as the Wechsler series, may not be sufficient to diagnose developmental language disorders in older children and adolescents. Diagnosing developmental language disorders is difficult in adults if there is no antecedent history of disordered language.

Management

The management of developmental language disorders focuses on (1) provision of language intervention services, (2) management of associated disorders, and (3) a preventive mental health approach. Language services may be delivered in a variety of ways: individual, group, or indirectly (eg, consultation to the classroom teacher). In cases that appear to be refractory to therapy, circumvention strategies and augmentative methods of communication may be warranted.

Each child has a unique language profile that may be impacted by cultural, social, and language factors of the home. There may even be neurobiological sex differences in some individuals with developmental language disorders (65). These factors must be considered when planning intervention. The goal of early language intervention is to stimulate overall language development and to teach language skills in an integrated fashion and in context, to improve everyday communication and the family’s ability to support the child’s development. Services and supports are individualized for each child and family. The frequency and degree of intervention can vary from direct to indirect speech and language services. When language disorders are present with other identified conditions, such as intellectual disabilities, autism spectrum disorder, and hearing impairment, direct speech and language services are indicated and are coordinated with other professionals working with the child. Treatment goals are selected based on developmental appropriateness and potential for improving the effectiveness of communication, academic, and social success within the child’s natural environment. Augmentative or alternative communication methods may be considered when appropriate. Research has shown that use of augmentative or alternative communication may aid in the development of natural speech and language (106). For elementary school children with language difficulties, the focus of intervention is curriculum-based and addresses language needs within the context of the classroom environment. Higher-level language skills, including literacy skills or metalinguistic skills may also be targeted for intervention. As curriculum demands increase for secondary school students and it becomes more difficult to close the gap between skill level and grade level, intervention tends to focus on strategies to compensate for language deficits, such as self-advocacy and an emphasis on how to learn rather than what to learn. Difficulties with language impairment can continue to impact functioning in post-secondary and vocational settings, which require individualized disability or vocational support services.

A number of therapy outcome studies are available, but they have been hampered by a low number of subjects, variable and often short therapy timeframes, a variety of treatment methods, and the targeting of different aspects of speech, language or communication skills. Limited long-term outcome studies are available. Some meta-analysis data are available with some indication of efficacy in the treatment of speech disorders and expressive language disorders (72; 32; 29; 153; 50). Advances in research indicate an evidence base supporting the efficacy of treatment of phonological disorders, speech production, and language difficulties (89). There are also efforts to systematically integrate evidence drawn from research and practitioner experience on the effectiveness of interventions for speech and language disorders (73). Research in the treatment of language and behavior in conditions such as autism spectrum disorder supports the importance of early identification, early intervention, and strategies that involve behavioral and naturalistic developmental intervention (110).

The impact of dose and frequency of interventions has been an area of study interest. When administered at an adequate intensity, variation in the dose and dose frequency of interactive book reading does not appear to influence word learning by children with developmental language disorder (128). Although interactive book reading continues to show promise as an effective word-learning intervention for children with developmental language disorder, further development is needed to enhance the effectiveness of this treatment approach. Children with developmental language disorder are likely to benefit from interventions aimed at improving their emotional awareness in addition to language interventions (109).

Outcomes

Early intensive intervention in 3- and 4-year-old children positively affects phonological expressive and receptive skills, and acquisitions are maintained in the medium term (105).

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Contributors

All contributors' financial relationships have been reviewed and mitigated to ensure that this and every other article is free from commercial bias.

Author

Ryan W Y Lee MD

Dr. Lee of the John A Burns School of Medicine at the University of Hawaii has no relevant financial relationships to disclose.
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Editor

Ann Tilton MD

Dr. Tilton has received honorariums from Allergan and Ipsen as an educator, advisor, and consultant.
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Former Authors

Bruce K Shapiro MD
Gaye Arakaki MS CCC-SLP
Rita Panoscha MD
Michael V Johnston MD†

Patient Profile

Age range of presentation: 1 month to 44 years
Sex preponderance: male>female, >2:1
Heredity: heredity may be a factor
Population groups selectively affected: none selectively affected
Occupation groups selectively affected: none selectively affected

ICD & OMIM codes

ICD-10: Communication disorder not otherwise specified: F98.8

Expressive language disorder: F80.1

Specific speech articulation disorder: F80.0
ICD-11: Developmental language disorder: 6A01.2

Developmental speech or language disorders: 6A01

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Developmental language disorder

Associated Disorders

Anxiety disorders
Attention deficit hyperactivity disorder
Autism
Head injury
Hearing impairment
- Landau-Kleffner syndrome
- Lead poisoning
- Maternal toxemia
- Mental retardation
- Neurodegenerative disorders
- Personality disorders
- Sex chromosome abnormalities

Differential Diagnosis

hearing impairment
disordered speech sound production
verbal apraxia
intellectual disabilities
attention deficit hyperactivity disorder
- traumatic brain injury
- psychological/emotional disorders
- autism spectrum disorder
- Landau-Kleffner syndrome
- neurodegenerative disorders

Developmental language disorder …

Developmental language disorder

Introduction

Overview

Key points

Historical note and terminology

Clinical manifestations

Presentation and course

Prognosis and complications

Clinical vignette

Biological basis

Etiology and pathogenesis

Epidemiology

Prevention

Differential diagnosis

Diagnostic workup

Management

Outcomes

References

Contributors

Author

Editor

Former Authors

Patient Profile

ICD & OMIM codes

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Also in This Category

Acute cerebellar ataxia in children

Wilson disease

Zika virus: neurologic complications

Anti-LGI1 encephalitis

Cerebral edema in childhood

Fatal familial insomnia

CNS germinoma

Vein of Galen malformations

Developmental language disorder

Introduction

Overview

Key points

Historical note and terminology

Clinical manifestations

Presentation and course

Prognosis and complications

Clinical vignette

Biological basis

Etiology and pathogenesis

Epidemiology

Prevention

Differential diagnosis

Diagnostic workup

Management

Outcomes

References

Contributors

Author

Editor

Former Authors

Patient Profile

ICD & OMIM codes

This is an article preview. Start a Free Account to access the full version.

Questions or Comment?

Also in This Category

Acute cerebellar ataxia in children

Wilson disease

Zika virus: neurologic complications

Anti-LGI1 encephalitis

Cerebral edema in childhood

Fatal familial insomnia

CNS germinoma

Vein of Galen malformations

This is an article preview.
Start a Free Account
to access the full version.