Speak Out OCTOBER 2019 V3 DIGITAL EDITION

o Narrative: poor narrative comprehension, especially with inferential questions. Attempts a story retell but tends to simply describe the pictures using short phrases and sentences (story classified as descriptive sequence) Interpretation Based on Peter’s profile and age, what are the critical issues to consider in identification of Developmental Language Disorder (DLD)? If we return to the definitions offered to us in Catalise 1, we see a number of factors that are key to identification/diagnosis: “PERSISTENT language difficulties with SIGNIFICANT IMPACT on social and educational progress”; Our other key guiding thoughts should consider recommendations 11 and 12: 11. A low score on a language test should be interpreted in relation to information from observation and interview; functional impact as well as test performance needs to be taken into account when identifying the child’s needs. 12. There is no clear cut-off that distinguishes between language impairment (regardless of its cause) from the lower end of normal variation of language ability. Key issues Here we discuss some of these key issues, and identify factors to consider and present some ideas, for this case. Issue 1: Peter’s age Although language skills are thought to be more stable from 4 years of age, at 4 years 8 months, he still falls into the age range where it is difficult to determine if language difficulties will persist. Factors: The involvement of a range of areas of difficulty (semantics, syntax, morphology), across comprehension and expression are of concern, and there is clear evidence of functional impact. Ideas: One possibility might be to offer a period of tier 2 small- group intervention on oral comprehension/inferencing skills and vocabulary skills. The role of speech pathologists within a tiered approach to service delivery has been the recent topic of a discussion paper (Ebbels et al., 2019), encompassing the ideas of universal, targeted and specialist services also discussed by Law et al. (2013). A short period of evidence supported intervention, designed and delivered by a speech pathologist/ educator collaboration (i.e., tier 2), would allow evaluation of Peter’s response to intervention and insight into the persistence of his difficulties. Issue 2: Diagnostic label Given his age, should we identify this as a language delay? Factors: Peter is still young (below 5 years of age), his test results are not severely below the normal range, and his mother is not concerned Ideas: Catalise would not recommend the use of the label “delay”, for a number of reasons. First, it implies the issue is less serious and will resolve, and data show we struggle to identify who will catch up. In fact, we do not have any means to distinguish delay vs. disorder and test scores cannot do this; there is no evidence for flat vs spiky profiles. If we do not have enough evidence to identify a language disorder or developmental language disorder (e.g., it is not clear if the language difficulties are persistent – see our previous suggestion of providing a short period of intervention to determine his response to intervention), we suggest the use of the term language difficulty in the first instance. Another option would be to use the term provisional.

We would give Peter a provisional diagnosis of a developmental language disorder. Further actions Following your response to the ECE’s concerns about Peter, including your direct observations at the early learning centre, and your sharing of results with Peter’s parents as well as Sarah, you are asked to present a brief overview of the role of an SLP at a staff meeting. During that meeting you discuss the importance of adopting a collaborative model for oral language and pre-literacy skills, which will not only benefit Peter but will also be useful for other children attending the centre. Three weeks later, with an increased awareness of early language and literacy development during the preschool years, the ECE team identified two other children who presented quite similar to Peter, but as those children were generally quiet they had not been identified before. Following your assessment (see above), you assist the ECE (Sarah) with creating a tier 2 group with these students, and provide the ECE team with strategies for building language and early literacy skills (such as print- and word awareness). Final words for now Discussing the impact of language disorder with parents and identifying the persistence of this disorder would empower the family to advocate for Peter to access funding and supports once he enters school. It is likely that Peter will be at risk of literacy problems too. As an SLP, we could offer to write a report as part of his school admission process or contact the SLP who works in that school to ensure the SLP and the school exec are aware of Peter’s language difficulties and how they may impact his participation throughout his school career. We would also want to use this opportunity to increase awareness of DLD in general, taking on a broader advocacy role. Mary Claessen , PhD, Curtin University of Technology Suze Leitao , PhD, Curtin University of Technology Natalie Munro , PhD, University of Sydney Tanya Serry , PhD, University of Melbourne Marleen Westerveld , PhD, Griffith University REFERENCES Bishop, D. (2013). Children’s Communication Checklist (CCC-2) (pp. 614- 618). Springer New York. Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & The CATALISE Consortium. (2016). CATALISE: a multinational and multidisciplinary Delphi consensus study. Identifying language impairments in children. PLOS One , 11(7), http://dx.doi.org/10.1371/journal. pone.0158753 Ebbels, S. (2014) Introducing the SLI debate. International Journal of Language and Communication Disorders . 49, 377-380. http:// onlinelibrary.wiley.com/doi/10.1111/1460-6984.12119/full Ebbels, S. H., McCartney, E., Slonims, V., Dockrell, J. E., & Norbury, C. F. (2019). Evidence-based pathways to intervention for children with language disorders. International Journal of Language & Communication Disorders , 54(1), 3-19, doi:10.1111/1460-6984.12387. Law, J., Reilly, S., & Snow, P. C. (2013). Child speech, language and communication need re-examined in a public health context: a new direction for the speech and language therapy profession. International Journal of Language & Communication Disorders , 48(5), 486-496. Address correspondence to Nichola Harris nharris@ speechpathologyaustralia.org.au , or Associate Professor Marleen Westerveld, m.westerveld@griffith.edu.au

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