Developmental Language Disorder (DLD)

What DLD is

Language is the system of words and rules used to share meaning. DLD affects the ability to learn this system, even though the child has normal hearing and typically has nonverbal intelligence within the broad typical range. It is a neurodevelopmental condition: the brain processes language differently. It is not caused by parenting, bilingualism or lack of effort.

DLD is different from:

• Speech sound disorders, where a child knows the words but has trouble making sounds clearly
• Stuttering, which affects fluency
• Late talking alone: many toddlers who start talking late catch up by school age. DLD is diagnosed when difficulties persist, usually after age 4 or 5

The older term was specific language impairment (SLI). International experts agreed on the term DLD in 2017 (the CATALISE consensus).

Signs of DLD by age

Toddlers and preschoolers

• late first words and late word combinations
• a small vocabulary
• short, simple sentences and missing grammar words (for example "him go park")
• difficulty following simple instructions
• frustration or behavior problems linked to communication

School-age children

• trouble following multi-step instructions and classroom talk
• difficulty retelling events or stories in order
• word-finding problems: using "thing" or "stuff", long pauses
• grammar errors that persist, such as with tense ("yesterday I walk")
• difficulty understanding questions, jokes, idioms or inferred meaning
• problems with reading comprehension and writing

Teenagers and adults

DLD continues into adulthood, though it may look subtler: difficulty with complex language, written work, following fast conversation and expressing ideas clearly. This can affect exams, work and relationships.

Associated difficulties

• Reading: many children with DLD also have dyslexia or reading comprehension difficulties
• Attention: ADHD is more common
• Motor coordination: developmental coordination disorder is more common
• Social and emotional: difficulty making friends, anxiety, low self-esteem, and higher risk of being bullied

DLD vs autism and other conditions

Causes and risk factors

No single cause is known. Contributing factors include:

• Genetics: DLD often runs in families, and children with a parent or sibling with language or reading difficulties are at higher risk
• Male sex
• Premature birth and low birth weight in some studies

Diagnosis

1. Hearing test to rule out hearing loss, including from glue ear
2. Speech-language pathologist assessment: standardized tests of understanding and expression, language samples, and information from parents and teachers
3. Developmental and medical review by a pediatrician to look for other conditions
4. Psychology or educational assessment where learning, attention or reading are concerns

Diagnosis usually becomes clearer after age 4 to 5, but help should start as soon as concerns arise.

Treatment and support

Speech-language therapy

Therapy is individualized and may include:

• building vocabulary and word knowledge
• teaching grammar and sentence structure
• improving understanding of instructions, questions and stories
• narrative (storytelling) skills
• social communication skills
• strategies such as visual supports and self-advocacy

Therapy may be delivered directly, through teachers and parents, or in groups.

School support

In the US, children with DLD may qualify for an Individualized Education Program (IEP) or a 504 plan, providing speech-language services, classroom accommodations (extra time, visual instructions, pre-teaching vocabulary), and reading support.

Strategies at home

• talk with your child often, following their interests
• use short, clear sentences and give one instruction at a time
• model correct language rather than correcting directly ("Yes, he went to the park")
• read together daily and talk about pictures and stories
• give your child extra time to respond
• use gestures, pictures and routines to support understanding

Outlook

DLD is lifelong, but with support many children make strong progress in communication, learning and confidence. Early identification and ongoing support through school years improve educational outcomes and reduce social and emotional difficulties.

Frequently asked questions

What is developmental language disorder?

DLD is a lifelong condition that makes it hard to learn, understand and use spoken language, without another known cause such as hearing loss or autism. It affects about 7 percent of children and often impacts reading, learning and social life.

What are the signs of DLD?

Signs include late talking, short or simple sentences, grammar mistakes that persist, difficulty finding words, trouble following instructions, and difficulty retelling stories. In school, children may struggle with reading comprehension and writing.

What is the difference between DLD and speech delay?

Speech delay often refers to a toddler who is late to talk and may catch up. DLD is diagnosed when language difficulties persist beyond about age 4 or 5 and affect everyday life. Speech sound problems, which affect pronunciation, are a separate issue.

Is DLD a form of autism?

No. DLD and autism are different conditions, though they can co-occur. In DLD, the main difficulty is language, while social interest and nonverbal communication are typically intact. Autism involves differences in social communication and restricted or repetitive behaviors.

Can DLD be cured?

DLD does not go away, but speech-language therapy, school support and home strategies help children improve their language skills and learn ways to manage. Many adults with DLD do well with the right support and understanding.