Language and communication disorders — structured clinical viva

This is impairing DLD with secondary behavioural crisis, literacy failure, bullying, possible ADHD, and parental demand for medication to 'fix talking' — not a primary antipsychotic or stimulant-first scenario. Validate distress, reframe aggression as often communication-driven, and hold a dual plan: intensive SLT/education supports plus careful psychiatric comorbidity work.^[2][5]

Formulation. Neurodevelopmental language disorder (CATALISE DLD) with mixed receptive-expressive impairment, literacy cascade, social stress from peer victimisation, and possible ADHD. Pragmatic concerns on CCC-2 with negative ADOS → consider pragmatic weaknesses secondary to language/social stress rather than automatic SPCD; SPCD would require persistent social-use deficits not better explained by structural language disorder or ASD, and ASD is not supported here.^[1][4][8]

Core treatment. Name speech-language therapy as definitive for language; Law meta-analysis supports efficacy especially for phonological/expressive targets. School accommodations and literacy intervention linked to oral language (Snowling). Anti-bullying and restorative school plan to reduce exclusion cycles.^[3][6]

Medication counselling. No tablet fixes core DLD. If ADHD criteria are clear after language-accessible assessment, discuss stimulant/non-stimulant pathways with monitoring — framed as treating attention comorbidity, not speech. Avoid antipsychotics for communication-driven behaviour without specialist justification.^[3][5]

Bilingualism. Does not cause DLD; keep home language; assess both languages.^[1][2]

Prognosis/risk. Language impairment elevates later internalising/externalising risk (Yew); early support and comorbidity care improve function. Prevalence context: clinically important language disorder is common (~7–8% order at school entry).^[5][7]