It’s that time again! After a brief hiatus due to family “stuff” I am back to doing Research Tuesday. With any luck I will be able to keep up the routine…I know I’m happier when I actually get things done on here…and it’s been WAY too long since I had a post! 

Today’s research Tuesday discusses the need (or lack of) for providing a “label” for unexplained language issues in children. To be fair, I need to warn you though…this is not “research” in that there’s controls, things that are done, and data to graph…It is research in that it’s compiling a lot of information, asking some tough questions, and posing challenges. The author is a much respected SLP who is available on many social media platforms and I truly hope I don’t upset her with this discussion. I found the article extremely helpful…and the discussion articles following this one were insightful. So..without further adieu Research Tuesday!

Article: Ten Questions about Terminology for Children with Unexplained Language Problems. (A Review)

Author: D.V.M. Bishop

My sincerest apologies to the author D.V.M. Bishop if I misunderstood or glossed over important elements to the article.

Background: Language appears to be the “red-headed stepchild” of the diagnostic world. By that I mean, for nearly every other potential difficulty there is a specific, consistent diagnosis (with the possible exception of CAS). Labels such as Dyslexia, ADHD, Autistic Spectrum Disorder, are all known, specific disorders. However, there exists no such cut-and-dried label for unexplained language difficulties. This difficulty is confounded by the recent DSM-V changes.

Purpose: The purpose of the study was to consider whether or not there is a need to have labels for unexplained language problems. A secondary purpose was to determine which terminology is appropriate in the event a label is needed.

Questions: After providing short scenarios, the article asks important questions.

1. Should we be concerned about children’s language problems?
2. Should we abandon diagnostic labels?
3. Is a medical model appropriate for unexplained language problems in children?
4. What are appropriate criteria for identifying children’s language problems?
5. Does it make sense to focus on specific problems with language?
6. Are language problems distinct from other neurodevelopmental problems?
7. What labels have been used for unexplained language problems?
8. What are the consequences of the lack of agreed terminology.
9. How might we enhance positive consequences, and avoid negative consequences, of labeling?
10. What terminology should we adopt?

 Discussion: 

(There are so many great points to this article…and knowing me and my tendency to wander, I may be hard pressed to stay coherent…but I will do my best.)  I’m going to be completely honest here and tell you I had intended to answer each question individually…but, the points that the author makes are great, well-thought out points, and really deserve your attention. I am going to highlight a few things that really resonated with me…(and hopefully you will bear with me and come back next month for another Research Tuesday).

As we know, some children are simply “late-talkers” and will “outgrow” any difficulty. However, for many children, this is simply not the case. Whether it’s due to socio-economic disadvantages, language poor households, lack of instruction, or whatever, some kids simply do not gain the language needed to be successful in school.  The article discusses the fact that children with language deficits that continue to school-age have a poorer prognosis to catch up effectively.

[I’ve sat on the fence a couple of times with the idea of labeling children. I dislike pigeon holing someone and saying X is Y, when in reality X may be ZDjC and Y. Some people have difficulty seeing beyond the label and seeing the child for the child. In that instance, labeling can be dangerous…However…back to the article.]  The author discusses both the pros and cons of labeling and provides a handy chart. Ultimately, by not labeling we deny there may be a biological impact causing problems. By not labeling, it is easy for agencies (educational and government) to minimize children’s difficulties. Also, no labels hampers research by not allowing researchers to identify diagnostic criteria. I really liked this section: 

“Labels may give the impression that they offer explanations for children’s difficulties, especially when they are medical-sounding, like ‘dyslexia’ or ‘Asperger syndrome’, but in fact these are behaviourally defined conditions, and the labels are really no more than shorthand descriptions of a cognitive profile. The drawback of medical labels is that they can lead to what Hyman (2010) has termed ‘reification’: the assumption that our labels are defining ‘natural kinds’.”

The article discusses the criteria needed for identifying language problems. For instance, what do we exclude? What do we include? Obviously, if we’re looking at labeling a language disorder, we may want to exclude known genetic conditions. We do not classify as student with Down Syndrome as “language impaired,” we know there are typically communication difficulties associated with that syndrome. The same with Autism Spectrum Disorder…it’s not likely that some one will receive a medical diagnosis of ASD that does NOT have a communication difficulty (it’s part of the criteria in the DSM).  However, there are children with ASD who have similar language difficulties as those with a Specific Language Impairment. Conversely, there are those that have pragmatic language deficits but are not ASD. What about those syndromes that are rare or that doesn’t always manifest in a language problem? What about hearing loss? Can we identify someone as language disordered because they have been socially deprived and don’t have the experiences to build language? 

Ultimately, the author discusses the need to provide a label to those children with unexplained language problems…but that we need to agree on the terminology and the criteria for the label. She states, that while labels can have a negative consequences, the consequences of avoiding labels is worse. Many of us are familiar with the term “Specific Language Impairment”; however, the author states that perhaps we need to use a different, more precise label such as “Primary Language Impairment” or “Language Learning Impairment”.  [She mentions the possibility of using “Developmental language impairment” however, I would caution against that as many insurance companies will not pay for services for anything that is labeled “developmental”.] 

As I stated earlier, I found the article very interesting and HIGHLY recommend that you go read it in it’s entirety. Unfortunately, in the length needed for a blog post there is simply no way to do justice to this article; however, the questions it posed as thought provoking and worthy of a post. Now…go…read it! Also, be sure to check out the other Research Tuesday posts over at Gray Matter Therapy. 

 I’d love to hear your thoughts…drop me a line about whether or not you use labels…and what you thought of the article. 

Until then…Adventure on!

Mary