The way that DLD impacts children’s language use is that they may struggle with pragmatics, which includes challenges in understanding and using nonverbal cues, turn-taking in conversations, maintaining appropriate eye contact, and adapting language to different social contexts. These pragmatic difficulties can hinder their social interactions and communication effectiveness. Secondly, children with DLD may encounter challenges in narrative skills, such as organizing their thoughts coherently, using appropriate story elements, and maintaining a sequential and logical narrative structure. Their narratives may lack key details and exhibit limited cohesion.

Language use impacts with FXS

• Males diagnosed with FXS may have difficulties with topic maintenance in conversations and eye gaze. 

• Females diagnosed with FXS may have difficulties with topic maintenance and initiating conversations. 

Autism spectrum disorder is a neurological disorder that affects social skills, learning, communication, and behavior. A language delay or disorder can be a symptom of autism.

Diagnostic Criteria

According to the DSM-5, a child has to have persistent deficits in the following three areas of social communication and interaction:

• Deficits in social-emotional reciprocity (back-and-forth conversations, sharing of interests, initiating or responding in conversations, etc.)

• Deficits in nonverbal communication used for social interactions (eye contact, body language, gestures, facial expressions, etc.)

• Deficits in developing, understanding, or maintaining relationships (sharing imaginative play, making friends, interest in having peers, etc.)

In addition, they need to demonstrate at least two of the following restricted, repetitive, patterns of behavior:

• Stereotyped or repetitive motor movements, use of objects, or speech

• Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior

• Highly restricted, fixated interests that are abnormal in intensity or focus

• Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment

Language content refers to the meaning of language. Impacts on language content in young children with autism may include:

• Difficulty in answering wh- questions, specifically why questions. 

• Abstract information (double meaning like glasses and glasses) 

• Idiom phrases like "light as a feather" or "it's raining cats and dogs"  

Language form refers to the structure of language. Impacts on language form in young children with autism may include:

• Difficulties in sentence structure (syntax) 

• Simpler structures of sentences

• Difficulties with morphemes (possessives, contractions, plurals, etc.)

Language use refers to the context in which language is used. Impacts on language use in young children with autism may include:

• Difficulty understanding gestures

• Difficulty maintaining eye contact

• Difficulty with expressing needs and wants

• Difficulty with emotional and behavioral regulation

• Repetitive speech (echolalia and/or scripting)

• Difficulty with social cues 

Impacts on Language Content - Semantics:

1. May learn words more slowly (e.g., have a less expansive lexical inventory) than their normal hearing peers. 

2. May have find it more challenging to learn abstract words (e.g. happy, shy, tired, confused) than concrete words (e.g. dog, horse, shoe, cupcake). 

Impacts on Language Form:

1. Syntax: May struggle with understanding and using complex sentences.

2. Morphology: May struggle with understanding and using morphemes at the end of the word (e.g., -ed, plural s, -ing).

Impacts on Language Use - Pragmatics:   

1. May exhibit poor social behaviors (e.g., turn-taking, topic maintenance) due to lack of access to the communicative exchanges around them

2. May become isolated due to hearing loss, deterring their use of different functions of communication (e.g., instrumental, regulatory, imaginative)

(ASHA, n.d.; Halliday et al., 2017; Lederberg et al., 2013)

Down syndrome can be diagnosed as a newborn most typically based on facial appearance and features associated with Down syndrome. Tests and screeners can also be done during the first and second trimester of pregnancy to assess the presence of Down Syndrome.

According to the Down Syndrome Resource Foundation, those with Down syndrome may exhibit delayed language development. This might mean it takes longer for children with Down Syndrome to learn language skills compared to typical peers of their age. 

Impacts on Language Content:

1. Children with Down syndrome may have difficulty understanding abstracts/words with double meaning.

2. Children with Down syndrome may have delayed vocabulary acquisition.

Impacts on Language Form:

1. Those with Down syndrome may present with less mature syntax/sentence structure. They may use jargon, preservation and difficulties with presuppositions.

2. Delays may be demonstrated in a decreased mean length of utterance (MLU), indicating difficulty using morphemes and syntax.

Impacts on Language Use:

1. Children with Down syndrome may have difficulty  making requests.

2. Children with Down syndrome may have difficulty initiating conversation/topics.

Childhood Apraxia of Speech (CAS) is a neurological disorder consisting of inconsistent movements and decreased proficiency due to neuromuscular deficits affecting the child's ability to communicate their thoughts. CAS is a speech sound disorder that affects the planning and programming of movement sequences for speech. Children with CAS typically have inconsistent and imprecise sounds and syllables (Morgan et al., 2018). Other characteristics of CAS include difficulty coordinating movement from syllables, inappropriate prosody such as inaccurate stress on vowels, constant distortions, and a slower rate of speech. 

Impacts on Language Content:

1. Children with CAS may demonstrate difficulty with word order and being able to link words together in a cohesive and comprehensive manner. 

2. Semantics contributes to the arrangement of words in sentences and phrases. Due to deficits in the planning and programming of movements for sequential speech, children with CAS may have difficulty with accurate sentence structures. 

Impacts on Language Form:

1.  CAS impacts a child's phonological skills by producing a distortion of vowels and inconsistent consonants. This affects the child’s speech by possibly changing the meaning of words that they are attempting to convey.  

2. Morphological errors are consistent with CAS, particularly omitting final consonants. 

Impacts on Language Use:

1. Due to the child having variable motor movements that impact language form, it could be difficult to use language to express wants and needs. In some cases, AAC is an option so the child can use language and communicate in their environments

2. Considering the unintelligibility of a child with CAS, their ability to form relationships and complete functional daily activities with same-aged peers may be affected. 

Williams Syndrome is a genetic condition caused by the deletion of 26-28 genes on chromosome #7 at the time of conception. The condition usually manifests in distinct facial characteristics (broad forehead, small chin, flat nasal bridge), cardiovascular difficulties, intellectual disability, and other learning disabilities. Individuals with this condition are often sociable and highly verbal, with many demonstrating a strong affinity for music. In addition to these typical characteristics, those with Williams Syndrom may also have some or all of the following: sleep problems, ocular issues, hearing loss, dental problems, gastrointestinal difficulties, urinary tract abnormalities, and musculoskeletal issues. As the presentation of symptoms are variable, speech/language therapy for individuals with Williams Syndrome should consider the unique constellation of symptoms at play. 

Impacts on Language: 

Children with WS typically perform well on verbal subtests, with particular strengths noted for concrete vocabulary and phonological processing and relative weaknesses in the areas of relational/conceptual language, reading comprehension, and pragmatics. With systemic phonics instruction, individuals with WS can usually advance to a high school reading level by adulthood, though writing is often a challenging component of communication for this population. 

Despite high rates of intellectual disability within this population (roughly 75%), and frequent articulation difficulties due to low muscle tone, children with this condition are usually conversational and highly social. While this is an inherent strength that can contribute to positive social interactions across a broad range of communicative functions, children may require support to address extreme social disinhibition. Additionally, underlying executive function deficits can undermine these children's generative language strengths by making it difficult to attend to conversational partners or teachers and process information. 

Impacts on Content: 

• Difficulties with vocabulary and language related to spatial, quantitative, temporal, and dimensional concepts. 

• Hyperverbal speech (excessive use of stereotyped phrases, over-familiarity, introduction of irrelevant experiences, perseverative responding).

Impacts on Form: 

• Low muscle tone often decreases articulatory precision, impacting overall intelligibility (with 50% and 82% receiving scores reflecting at least mild deficits on Focal Oral Motor Control and Sequencing, respectively). 

• Grammatical constructive abilities of children with WS correspond closely with IQ, though children may demonstrate difficulty with complex grammatical constructs. 

Impacts on Use: 

• Common problems included difficulty integrating eye contact. 

• Children may not use dolls/toys as independent agents during play. 

• Restricted interests may limit ability to functionally participate in conversations. 

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental diagnosis in childhood, according to the CDC. Diagnostic criteria for ADHD includes completion of a medical exam, hearing and vision tests, completion of a checklist which rates ADHD symptoms, and taking a comprehensive medical history of the child. ADHD is typically formally diagnosed beginning at age four, but children can display symptoms younger in toddlerhood. ADHD is typically diagnosed in adulthood and lasts into adulthood. Children with ADHD may experience more challenges with learning and see an SLP for a range of clinical problems related to language that contribute to their challenges with learning.

Common signs and symptoms of ADHD:

• forgetting and losing items

• squirming and fidgeting

• excessive talking and challenges maintaining topics

• taking unnecessary risks or making careless mistakes

• trouble with inhibition, turn taking, getting along with other children 

• daydreaming

Children with ADHD are more likely to have language processing difficulties rather than a language delay. Difficulties with language may become more prevalent when the child becomes school aged, as conversations and ideas presented become more complex. It should be noted that not all children with ADHD have language difficulties.

Children with language may experiences challenges with language in the following areas:

• Auditory Processing

  • The ADHD population often has related auditory processing difficulties including following directions and retaining information from readings and listening to spoken communication

  • Children with ADHD may have impacted speed of processing, auditory memory and attention, processing of auditory information, auditory analysis and auditory discrimination 

• Metacognition

  • Simply put, metacognition is thinking about thinking. This involves the child knowing what they need to know and understanding what they need to know in order to learn and develop language

  • Children with ADHD may have challenges with the strategies involved in problem solving, which is involved in navigating conversations and necessary for many pragmatic situations

Impacts in Language Content:

• Children with ADHD may have tangential narratives as they're having a hard time attending to conversations or staying on topic - which they made require more processing time to organize their thoughts and access the vocabulary they're looking for

• Challenges in semantics may include: poor vocabulary, word-finding difficulties and difficulties using context to help with the comprehension of reading

Impacts in Language Form:

• Studies have shown that children with ADHD are at risk for articulation disorders - which impact their ability to produce phonemes and sound combinations that are age appropriate. Challenges with morphology and phonology may present 

  • Compared to peers with learning disabilities alone, children with ADHD showed increased volume and variability in pitch when speaking

  • Displayed particular patterns such as increased number of vocal pauses, which may be secondary to requiring longer processing time and needing to organize thoughts

• Some studies have shown children with ADHD score lower in Phonological Awareness, Access to Lexical and Phonological Memory compared to children with typical development.

Impacts in Language Use:

• Children with ADHD may produce more vocal repetitions or word fillers as they attempt to organize their thoughts while speaking, which may present similar to a stutter

• Pragmatics encompass social aspects related to spoken language and nonverbal communication. ADHD symptoms impact this aspect of communication in children

  • Some examples include: blurting out answers, interrupting, talking excessively, and speaking too loudly

  • Children with ADHD may make tangential comments in conversation, or struggle to organize their thoughts

  • Some may have difficulty inferring meaning such understanding idioms and analogies

Intellectual disability

According to ASHA (American Speech-Language-Hearing Association), Intellectual disability (ID) is a language disorder related to decreased growth and development of the brain. In regard to diagnostic criteria, ID is characterized by 3 factors: significant difficulties in adaptive behavior (i.e., mental, social, and practical abilities for everyday living); significant restrictions in cognitive functioning (such as learning, reasoning, and problem-solving), and beginning in the developmental stages (before the age of 22).

Defined as a language disorder, children with ID may demonstrate reduced cognition skills necessary for the development and use of language via spoken or written modalities. In some cases, reduced communication skills falling within verbal (e.g., talking) and nonverbal (e.g., facial expressions) means are also present. Other disorders like ASD and Epilepsy can co-exist with ID. 

Impacts on language Content

• Children with ID may display weaknesses in phonological awareness. This means that they could have difficulty when working with sounds in spoken language. Despite this, they are still able to blend and segment syllables. This means that they can break apart and put back together syllables. They may have more difficulty separating letters and initial and final letter recognition. Overall, they usually have a pattern that is atypical with regard to phonological awareness and it changes over time as they grow older.

• The semantics of children with ID can be affected as well. In that case, they may experience difficulties with narrative skills. This might mean that for them to tell stories could be more challenging because of the decreased use of complex syntax and the increase in errors related to syntax in comparison to their typically developing peers.

impacts on language Form

• Children with ID may demonstrate impacted syntactic skills. Due to their difficulties with arranging words, they might use shorter and lower-complexity sentences to communicate.

•  Moreover, some challenges with morphological skills may occur. It can be difficult for them to understand how to use grammatical morphemes, what function words are, and how to use sentences that include a subject who doesn't act as the verb (i.e. passive sentences).

Impacts on language use

• Due to possible weaknesses in social abilities within a language to communicate and comprehend more complex contexts like feelings and thoughts, children with ID may face pragmatic challenges (i.e., social rules) such as decreased or absent empathy towards others. 

• It could also be difficult for these individuals to control their emotions, which can result in conflictual situations when socializing.

Auditory Processing Disorder, also referred to as Central Auditory Processing Disorder (CAPD), refers to the inability to process auditory information in the brain. It is not a hearing loss, but a disconnect between what a person hears and how their brain interprets that information.

People with APD may have:

• Difficulty understanding spoken language when surrounded by a noisy background or in a group setting with interlapping voices

• Request frequent repetition when being spoken to

• Misunderstanding of prosody and meaning behind messages

  • Difficulty with sarcasm and jokes

• Inconsistent responses when speaking to someone

• Poor musical comprehension skills

• Difficulty following complex, multi-step directions

Impact in language content

• Children with APD may have less access to correct speech sounds and therefore have more trouble learning and building their vocabulary as they progress through school.

• Children with APD may have trouble learning abstract words and being able to categorize them in a way that is meaningful and conducive to learning and expanding their schemas.

Impact in language form

• Children with APD may have trouble differentiating between different phonemes and auditory sequencing and blending, and in turn can display difficulty using and deciphering spoken language.

• Children with APD may have trouble with auditory discrimination and auditory memory, which can hinder progress in learning to read and understanding more complex language forms.

Impact in language use 

• Children with APD may be inconsistent in their comprehension of spoken language, which can affect their ability to consistently take turns, respond in group settings, and maintain topics during a conversation.

• Children with APD may have trouble with comprehending prosody behind a message and may misunderstand hidden meanings, sarcasm, and jokes.

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