What is developmental language disorder (DLD)?

What is developmental language disorder?

DLD is a long-term difficulty with talking and, often, with understanding words, that has no other known cause behind it. Speech and Language UK says a child can be diagnosed if the difficulties have a big impact on school or everyday life, aren't caused by another condition such as hearing impairment or autism, and aren't likely to get better by age five.¹

The name comes from a 2017 agreement among 57 experts from different professions and countries, known as CATALISE. They recommended "language disorder" for difficulties that cause problems in everyday life and are linked with a poor prognosis, and "developmental language disorder" when there's no known biomedical cause.² The same panel agreed that DLD can sit alongside other conditions such as ADHD, and that a child doesn't need a gap between their verbal and non-verbal ability to have it.²

"Disorder" is the name of the diagnosis, and I use it for that. It doesn't mean a child is broken. Many children with DLD have plenty of ideas and find it hard to put them into words or to take in what others say.¹

How common is DLD?

It's common. A population study screened 7,267 four- and five-year-olds across reception classes in Surrey, out of 12,398 children, and fully assessed a sample of 529 of them. It estimated that 7.58% of children have language disorder of unknown origin, and 9.92% have language disorder of any kind.³ The authors put it as roughly two children in every class of 30 having a language disorder severe enough to hold back their progress at school.³

The RCSLT uses the 7.58% figure,⁴ and RADLD, the awareness charity, describes it as a hidden but common condition affecting 1 in 14 people.⁵ Two cautions. It was one county, and the figure depends on where the line is drawn, so please read it as a good estimate and not an exact count. And a lot of people have never heard of it.⁶

What can DLD look like at 4, at 8 and at 13?

It changes as a child grows, and no list fits every child. The published guidance I've found doesn't give neat age-by-age lists, so these are the sources' general signs set against what I see at different ages.

Around 4

A child may not talk as much as others, find it hard to say what they mean, have language that sounds younger than their age, or struggle to find words. They may not understand or remember what's been said.⁷ In nursery that can look like a child who watches what everyone else does before joining in.

Around 8

The same difficulties are still there, and school adds new demands. Older children may find reading and written language harder.⁷ In my experience this is the age when long instructions get lost, and when retelling what happened at playtime comes out jumbled.

Around 13

Secondary school asks for a lot of fast, abstract language. A leaflet from an NHS therapy service, hosted by the RCSLT, lists trouble understanding instructions, limited vocabulary or word-finding, difficulty with idioms, jokes and sarcasm, and trouble with making and keeping friends.⁶ Speech and Language UK adds difficulty giving specific answers, telling ideas in order, and organising what to say or write.⁸ The leaflet also reminds parents that language difficulties can sit under low self-esteem, anxiety or misbehaving in class.⁶

How and when is DLD diagnosed, and by whom?

The RCSLT's guidance for therapists on diagnosing DLD says to take as full a history as possible from several sources, use clinical judgement and state any uncertainty. Telling DLD apart from other conditions may need a wider team, and it isn't the therapist's role to assess intelligence or diagnose a learning disability.⁹

On timing, the definition includes difficulties that aren't likely to resolve, which is why Speech and Language UK refers to age five.¹ My late talkers guide covers the toddler years. The RCSLT also notes that a therapist can use "DLD" provisionally, or "language disorder" as a wider term, while the full picture is still emerging.⁹

A hearing test is usually sensible, because DLD is only the answer when something like hearing loss doesn't explain the difficulty. I don't do hearing tests; your GP can arrange one.

Why is DLD often missed?

Because it's hidden. Speech and Language UK says the difficulties can be hard to spot and may stay hidden for a long time,¹ and RADLD calls it a hidden condition.⁵ A child with DLD may talk fluently, in long sentences, and still not follow what they're asked.

It also looks like other things. The secondary-school leaflet warns that language difficulties can show up as anxiety, low self-esteem or misbehaviour in class.⁶ A child who doesn't follow the lesson can look like they aren't listening. In my view children also get very good at coping, by copying classmates or by going quiet, which hides the problem further. That's my opinion from clinic and not a research finding.

What helps at home and at school?

Support that fits the child helps, and it needs to carry on over time, not just in one burst. The RCSLT says therapists teach strategies to children and the people around them, aimed at reducing the impact of the difficulty and building language as far as possible, and that support at transition points such as starting secondary school matters.⁴ DLD is described as lifelong, so people may come back to therapy at different stages.⁴

At home, these are things I'd try, from my own practice rather than a trial:

• Give your child time to answer, and say things in shorter chunks.
• Show as well as tell, with gestures, pictures or a quick drawing.
• Instead of "Do you understand?", ask them to tell you back what they're going to do.
• Talk about their ideas, and read together at whatever level feels good.

At school, tell the class teacher and the SENCO (special educational needs coordinator) what you've noticed. Helpful adjustments include splitting long instructions, checking understanding, and teaching the key words for a topic before the lesson. Again, that's common sense from practice. I can't promise any approach will work for a particular child.

When should I ask for help?

If you're worried, ask. The free first steps are your GP, your health visitor if your child is under five, and the SENCO at nursery or school, and a hearing check is a sensible part of it. Speech and Language UK also runs a free advice line with a speech and language therapist.⁸

If your child has lost words or skills they used to have, ask for an urgent GP appointment or call NHS 111.

What happens if I get in touch?

A free 15-minute call is the place to start, and you don't need a GP referral. If it makes sense to go on, the first step is an assessment at my Wanstead clinic for £270 and seeing me won't take your child off any NHS waiting list. How I work is on my language and communication page, this guide walks through an assessment, and prices are on the fees page.