News

This year it's practically March and we have just put the finishing touches on our annual lab newsletter! In our newsletter, we review the work our lab has been doing this past year. You can download a copy below, or email hannah.hobson@york.ac.uk to receive a copy. Thank you to everyone who has contributed to our work this year! 

Well, we didn't quite make January this year but hey! Our annual lab newsletter is a review of the work our lab has been doing this year. You can download a copy below, or email hannah.hobson@york.ac.uk to receive a copy. Thank you to everyone who has contributed to our work this year! 

drive.google.com/file/d/1ynJt0MFK8-Qw3a2O0zAiBeqDvfN9M-jL/view?usp=sharing 

Our newsletters contain a review of the work our lab has been doing this year! You can download a copy below, or email hannah.hobson@york.ac.uk to receive a copy. Thank you to everyone who has contributed to our work this year!

On DLD Awareness Day we had a webinar for medical and health care students! Students had so many good questions for our panel. We ran out of time and did not get to answer them all. So below are the questions we didn’t get to, with answers from Hannah Hobson (Psychology lecturer) and Helen Eales (SLT).

Does DLD get misdiagnosed as Autism Spectrum Disorder often?

Sometimes, children are referred for autism assessments as parents or professionals know the child is struggling but aren't sure why (perhaps they aren't aware of DLD). In some cases, it requires a professional (or team of professionals) with good knowledge of both conditions to understand whether a child is best described as having DLD or ASD (hereafter autism). A child with DLD might well be sent for an autism assessment before receiving their DLD diagnosis – in fact, language problems are a sign of autism in the early years. However, although their language problems can affect their ability to make and keep friends, children with DLD do not have the social difficulties that are though to characterize autism. At an autism assessment, a child with DLD may demonstrate abilities such as social reciprocity and joint attention, ruling them out of an autism diagnosis. 

Have there been fMRI studies done on people with DLD to show how the disorder might come about or present?

Yes, there have (though far fewer than conditions such as autism or ADHD). These have hinted that there are atypicalities in the functioning of brain regions involved in language. However, there is not a single brain region that separates out children with and without DLD, and study findings at the group level (i.e. comparing average brain activity in the DLD group versus the non-DLD group) disguise the fact that there is a lot of variation within DLD, neurobiologically speaking. So there is certainly evidence for the role of atypical brain structure and function – but it’s a complicated picture!

I am wondering if you’d have any insight as to how to create opportunities for doctors to recognize DLD and then link to SLTs. For instance, I feel parents may feel language difficulties are a result of lower intelligence or slow learning and not discuss it as a health-related issue that can be managed by healthcare professionals. Additionally, children may camouflage. So how could doctors begin this conversation and investigate DLD in a child?

This is a great question!

Detecting DLD can be challenging – my top tip would always be to take the time to check what children have comprehended. Asking “Did you understand that?” is not a great tactic – it is easy to say “yes”, even if you haven’t! Try “I just want to check you understood me, before we carry on. Can you tell me what I said would happen?” or “Okay, let’s make sure you understand the next steps - can you tell me what you need to do now?” These questions will help reveal how much your patients are actually understanding about what you are telling them. Also, think about how the child responds to other questions and instructions in your consultation - can they give you information about themselves? Can they describe what is wrong (if a medical appointment)? 

As to opening up conversations with parents - RADLD (Raising Awareness of DLD) has some great resources and factsheets about DLD – if you are starting to wonder whether a child’s problems might be related to a language problem, using these resources with your patients might be a good way to investigate what they think. There are DLD factsheets available in a number of languages here: https://radld.org/about/dld/dld-fact-sheet/ , and they have a YouTube channel with some parent and public friendly videos, including this one https://www.youtube.com/watch?v=8gHoyoM5wC8

The charity ICAN have a GP poster for speech and language difficulties for ages 0 -5 https://ican.org.uk/shop/gp-checklist-poster-set-of-10/ - perhaps we need to develop a DLD one!

When is a diagnosis appropriate?

Parents and their doctors may have concerns about overdiagnosis and attaching a label of a neurodevelopmental condition to a child early in their life – but it is important to bear in mind that we know that DLD is a lifelong condition, and that the sooner language problems are detected and recognised, the sooner they can be supported. Diagnosis should be made by a qualified speech and language therapist – if you have concerns about a child’s language, we recommend getting in touch with the relevant SLT service in your area. If parents would like to speak to someone about the process of SLT assessment/their concerns about their child’s language ICAN (a charity for children’s communication) have a parent telephone line, staffed by SLTs, who can provide initial help and guidance about what to do next: https://ican.org.uk/i-can-s-enquiry-service/

Working in a nursery I’ve worked with a child as their speech and language key practitioner. Listening to what Helen said I immediately thought of this child. He hasn’t been diagnosed with anything yet but the speech and language therapist is trying to work out what is going on. He’s 4. Is it likely he has DLD and it just can’t be diagnosed yet because he isn’t 5?

Your SLT may be reluctant to diagnose DLD while he is young, but you could ask her whether his profile would be explained by DLD, or a different speech, language and communication need. The SLT is likely to be monitoring him closely - at this age a key indicator of DLD is if/how quickly the child is progressing with their language in response to interventions. SLTs can diagnose before 5 if the evidence is clear, but this isn't common.  Things can change so quickly at this age it's important for the SLT to monitor and review regularly. 

I understand that DLD doesn’t really completely go away, but does it change over the lifespan?

Like other children, children and young people’s with DLD will show improvements in their language over time, though these may be very slow, and they will not reach expected levels and will always have some language and communication problems, even as adults. However, the effects of these language problems are likely to change. As children move through school, their learning may be increasingly reliant on oral language skills and literacy, and it may be harder for them to use other strategies that previously helped them to keep up. Teenagers’ social activities may also become increasingly difficult for young people with a language need: “banter” and group discussions may become challenging, leaving young people with DLD ostracised, or vulnerable to bullying. There are very few studies of DLD in adulthood, but longitudinal studies suggest that with appropriate support adults with DLD can work, enjoy relationships, and participate in society. However, detection and support are key.

Is there a possibility for a communication with DLD Patients session to be organised within the MBBS programs at HYMS?

What a fantastic idea! We would love to host more sessions for students! Watch this space!

Hannah Hobson appeared on the Association for Child and Adolescent Mental Health podcast to talk about language and communication problems, in particular their relationships to mental health, how mental health care for children with DLD is perceived by their parents, and the judgements and perceptions people make about children and young people with DLD. 

You can access the podcast here.