Psych · Child and adolescent psychiatry — neurodevelopmental
Language and communication disorders
Also known as Developmental language disorder · DLD · Specific language impairment · SLI · Speech sound disorder · Social pragmatic communication disorder · SPCD · Childhood-onset fluency disorder · Stuttering · Childhood apraxia of speech
Exam-exhaustive fellowship reference on language and communication disorders — DSM-5-TR/CATALISE classification, DLD vs SPCD vs ASD, epidemiology, SLT-first management including Lidcombe for stuttering, literacy and mental-health comorbidity. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Language regression after clear acquisition — exclude epileptic encephalopathy (e.g. Landau–Kleffner spectrum), neurological disease; urgent specialist review
- New seizures, focal neurology, progressive course, or cognitive regression — do not label pure DLD
- Unrecognised hearing impairment driving speech-language failure — audiology before or with developmental formulation
- Severe school exclusion, bullying, or self-harm secondary to communication shame — full risk assessment and safeguarding
- Misdiagnosis of oppositional behaviour when the child cannot comprehend instructions — reformulate and simplify language
- Diagnosing SPCD without a careful ASD differential (restricted/repetitive behaviours) — wrong pathway and supports
Meet the patient
A 5-year-old boy is referred for "behaviour problems and not listening". He throws tantrums when given multi-step instructions, his speech is unintelligible to anyone outside the family, and the school has labelled him oppositional. His mother quietly adds that he did not combine words until he was nearly three.[1][9]
Two questions are live. What level of language is failing here — speech, language, or pragmatics? And is "oppositional" the right frame, or is it the wrong word for a child who cannot decode what the adult just said? Mix the levels and you send the child to the wrong therapist with the wrong label.[1][12]
References12ShowHide
- [1]Bishop DVM, Snowling MJ, Thompson PA, Greenhalgh T; CATALISE consortium CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children PLoS One, 2016.PMID 27392128
- [2]Bishop DVM, Snowling MJ, Thompson PA, Greenhalgh T; CATALISE-2 consortium Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology J Child Psychol Psychiatry, 2017.PMID 28369935
- [3]Norbury CF, Gooch D, Wray C, et al. The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study J Child Psychol Psychiatry, 2016.PMID 27184709
- [4]Tomblin JB, Records NL, Buckwalter P, et al. Prevalence of specific language impairment in kindergarten children J Speech Lang Hear Res, 1997.PMID 9430746
- [5]Law J, Garrett Z, Nye C The efficacy of treatment for children with developmental speech and language delay/disorder: a meta-analysis J Speech Lang Hear Res, 2004.PMID 15324296
- [6]Jones M, Onslow M, Packman A, et al. Randomised controlled trial of the Lidcombe programme of early stuttering intervention BMJ, 2005.PMID 16096286
- [7]Norbury CF Practitioner review: Social (pragmatic) communication disorder conceptualization, evidence and clinical implications J Child Psychol Psychiatry, 2014.PMID 24117874
- [8]Swineford LB, Thurm A, Baird G, Wetherby AM, Swedo S Social (pragmatic) communication disorder: a research review of this new DSM-5 diagnostic category J Neurodev Disord, 2014.PMID 25484991
- [9]Yew SG, O'Kearney R Emotional and behavioural outcomes later in childhood and adolescence for children with specific language impairments: meta-analyses of controlled prospective studies J Child Psychol Psychiatry, 2013.PMID 23082773
- [10]Zubrick SR, Taylor CL, Rice ML, Slegers DW Late language emergence at 24 months: an epidemiological study of prevalence, predictors, and covariates J Speech Lang Hear Res, 2007.PMID 18055773
- [11]Snowling MJ, Hulme C Interventions for children's language and literacy difficulties Int J Lang Commun Disord, 2012.PMID 22268899
- [12]Shriberg LD, Tomblin JB, McSweeny JL Prevalence of speech delay in 6-year-old children and comorbidity with language impairment J Speech Lang Hear Res, 1999.PMID 10599627