Recently I read a terrific article written in 2014 by Sun and Wallach entitled: “Language Disorders Are Learning Disabilities: Challenges on the Divergent and Diverse Paths to Language Learning Disability“. I found it to be so valuable that I wanted to summarize some of its key points to my readers because it bears tremendous impact on our understanding of what happens to children with language disorders when they reach school years.
The authors begin the article by introducing a scenario familiar to numerous SLPs. A young child is diagnosed with receptive, expressive and social pragmatic language deficits as a toddler (2.5 years of age) begins to receive speech language services, which continue through preschool and elementary school until 2nd grade. The child is receiving therapy under the diagnosis of specific language impairment (SLI), which is characterized by difficulties with acquiring language in the absence of any other known disorders. By 2nd grade the child has seemingly “caught up” in the areas of listening comprehension and complex sentence production but is now struggling academically in the areas of reading and writing. Now his teachers are concerned that he has a learning disability, and his bewildered parent asks “Is it true that my child now has another problem on top of his language problem?”
From that scenario the authors skillfully navigate the complex relationship between language disorders and school disability labels to explain that the child does NOT have a new disorder but rather continues to face new challenges presented by his old disorder due to which he is now struggling to meet the growing language demands of the academic curriculum.
Here’s the approximate hierarchy of language development in young children:
- Exploration of the environment
- Play
- Receptive Language
- Comprehension of words, phrases, sentences, stories
- Expressive Language
- Speaking single words, phrases, sentences, engaging in conversations, producing stories
- Reading
- Words, sentences, short stories, chapter books, etc.
- General topics
- Domain specific topics (science, social studies, etc)
- Spelling
- Writing
- Words, sentences, short stories, essays
The problem is that if the child experiences any deficits in the foundational language areas such as listening and speaking, he will most certainly experience difficulties in the more complex areas of language which is reading and writing.
The authors continue by explaining the complexity of various labels given to children with language and learning difficulties under the IDEA 2004, DSM-5, as well as “research literature and nonschool clinical settings”. They conclude that: “the use of different labels by different professionals in different contexts should not obscure the commonalities among children with language disorders, no matter what they are called”.
Then they go on to explain that longitudinal (over a period of time) research has revealed numerous difficulties experienced by children with “early language disorders” during school years and in adulthood “in all domains of academic achievement (spelling, reading comprehension, word identification, word attack, calculation)…”. They also point out that many of these children with language disorders were later classified with a learning disability because their “later learning difficulties [took on] the form of problems acquiring higher levels of spoken language comprehension and expression as well as reading and writing”.
The authors also explain the complex process of literacy acquisition as well as discuss the important concept of “illusory recovery“. They note that there may be “a time period when the students with early language disorders seem to catch up with their typically developing peers” by undergoing a “spurt” in language learning, which is followed by a “postspurt plateau” because due to their ongoing deficits and an increase in academic demands “many children with early language disorders fail to “outgrow” these difficulties or catch up with their typically developing peers”.
They pointed out that because many of these children “may not show academic or language-related learning difficulties until linguistic and cognitive demands of the task increase and exceed their limited abilities”, SLPs must consider the “underlying deficits that may be masked by early oral language development” and “evaluate a child’s language abilities in all modalities, including preliteracy, literacy, and metalinguistic skills”.
Finally, the authors reiterate that since language is embedded in all parts of the curriculum “intervention choices should be based on students’ ongoing language learning and literacy problems within curricular contexts, regardless of their diagnostic labels”. In other words, SLPs should actively use the students’ curriculum in the intervention process.
In their conclusion the authors summarize the key article points:
- The diagnostic labels may change but the students linguistic needs stay the same. Thus clinicians need to a) “identify existing language/literacy needs that may have been unidentified previously” and b) provide “relevant and functional interventions that are curriculum-based and literacy-focused”
- “Early language disorders are chronic and tend to follow children through time, manifesting themselves differently based upon an individual’s inherent abilities”. Thus SLPs need to be keenly aware regarding the nature and timing of “illusory recoveries” NOT to be fooled by them.
- “Definitions of literacy have broadened” so “intervention goals and targeted language learning strategies should change accordingly to guide effective and relevant intervention“
- “Majority of learning disabilities are language disorders that have changed over time”.
I hope that you’ve found this article helpful in furthering your understanding of these highly relevant yet often misunderstood labels and that this knowledge will assist you to make better decisions when serving the clients on your caseload.
References:
Helpful Smart Speech Therapy Resources:
- The Checklists Bundle
- General Assessment and Treatment Start Up Bundle
- Multicultural Assessment Bundle
- Narrative Assessment and Treatment Bundle
- Introduction to Prevalent Disorders Bundle
- Social Pragmatic Assessment and Treatment Bundle
- Assessment Checklist for Preschool Children
- Assessment Checklist for School Children
- Language Processing Deficits Checklist for School Aged Children
Based on this premise, than it is pretty much the responsibility of the school SLP to remediate all the literacy problems? How do you decide when and what goes over to the SLD/ academic SPED services side of the equation then?
Everything depends on the model the school is operating within. Are the services complementary or supplementary? Who are the other literacy professionals? What is their experience and expertise and how can collaboration take place? Once these questions are answers the SLP decides how much literacy input will be given to the student and by whom?
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My question would be if it is often the opposite occurring. We often see a language disorder (poor comprehension, impaired development of syntax, poor vocabulary, difficulty using language effectively) in young children when the real cause of their difficulties is cognitive in nature. Not to say that providing the label of language impaired is inappropriate for these kids, but I frequently find that the learning disability drives the language difficulties, not the other way around. Poor short term memory, long term retrieval, fluid reasoning, and processing speed will all interfere with language development and performance. And of course these weaknesses will make learning hard! If we chalk all of the kid’s difficulties up to their original language impairment growing with them, we might be missing the whole picture of how best to educate the student.
YES!!!! I think we speechies tend to view it all through the lens of language but a child with a learning disability or cognitive deficit will first display those weaknesses in the area of language acquisition. There is such a reciprocal relationship between language and cognition and trying to separate the 2 (as some tests do) is truly an artificial construct. I cringe when I hear people talking about “just” a language disorder, as if everything else can be attributed to that. I totally agree with you that often, it’s the cognitive issues that drive the language deficits, not the other way round.
Little Dipper,
Certainly what you are describing with respect to the child’s expressive language abilities is a significant cause for concern. Firstly, a number of professionals to date have complained that the PLS-5 grossly over-inflates the child’s language abilities. You can find more in-depth information regarding that here http://leadersproject.org/sites/default/files/PLS5-English-finaldraft.pdf That implies that his receptive language abilities may be lower as well as that his expressive language abilities may be even more impaired then what the test revealed.
Secondly, I would continue serving this child by working with him to further improve his grammar and syntax conversational and narrative abilities. To assist you further I am attaching several useful links for your review
http://www.smartspeechtherapy.com/shop/pediatric-background-history-questionnaire/ (assists professionals with learning about history of special education and learning difficulties in the family to further decide regarding the need for continued intervention)
http://www.smartspeechtherapy.com/shop/recognizing-the-warning-signs-of-social-emotional-difficulties-in-language-impaired-toddlers-and-preschoolers/ (to assist the therapist with deciding whether the child’s linguistic deficits are having negative impact on their social emotional functioning)
please let me know if i can assist you further
For those of us working with children ages 24-36 months who were late talkers, what should we be most concerned about regarding their early language development as it relates to later linguistic demands? For example, I just administered the PLS-5 to a child who is age 31 months. He scored a 112 on the receptive subtest, but couldn’t answer the visual inferences question which is basically a short story. He has also been slow to combine words and initially began combining words with disordered syntax. If the issues discussed in the article show up in 2nd-4th grade, how can we help now? Thank you for the summary.
Thank you for this article. This article speaks to an issue that I have grappled with ethically for many years. Given limited resources, the students I work with are identified in SK with language delays and disorders, but only served by speech and language services till grade 2. An artifical discharge criteria in my opinion.
My background in cognitive linguistic communication disorders tells me we are failing many of the students we see. Psychological Educational Assessments provide a diagnostic label of Learning Disability, once the student is able to access the assessment Which can also take years. And then there is recognition of the need for continued accommodations. But many years separate the provision of speech and language services and the diagnostic label provided by the psycho-ed. assessment. Knowing that the higher level language skills will continue to be weak and interfere with a student’s academic success we are failing students by ignoring the elephant in the room. This article succeed in illuminating this situation and I very much appreciate reading it in print.
Thank you so much for this! I see this all the time too! So many children are dismissed from Speech & Language services only to start struggling when they hit fourth grade and the language demands increase with the academic demands. Many parents are upset, but this article will be so valuable in explaining what is really happening.
Thanks for this summary! I see this so often with my students who come up to Kindergarten with speech services only, and then begin to struggle academically around first or second grade. Parents are often disappointed that their children begin to struggle even though they have seen so much progress with their language skills. I think your picture of the iceberg says it all!