Maybe your child was a late talker who never quite seemed to catch up. Maybe they chat happily at home, but their teacher says they struggle to follow directions, or their sentences come out jumbled when they try to tell you about their day. If any of that sounds familiar, you may come across the term developmental language disorder, or DLD. Many parents have never heard of it, even though it's one of the most common conditions of childhood. This post summarizes what the National Institutes of Health and researchers have published about DLD, so you know what it is, what it can look like, and what to ask about.
What is developmental language disorder?
The National Institute on Deafness and Other Communication Disorders (NIDCD) describes DLD as "a communication disorder that interferes with learning, understanding, and using language." It adds that "These language difficulties are not explained by other conditions, such as hearing loss or autism, or by extenuating circumstances, such as lack of exposure to language," and that "DLD can affect a child's speaking, listening, reading, and writing."[1]
DLD is about language: understanding words and sentences, learning vocabulary, and putting words together with the right grammar. That's different from speech, which is about how sounds are physically made. (If the difference between understanding and talking is new to you, our post on receptive vs. expressive language explains it.)
Why haven't I heard of it before?
Partly because it has gone by many names. NIDCD notes that "DLD has also been called specific language impairment, language delay, or developmental dysphasia."[1] In 2017, an international panel of 57 experts, noting that a lack of agreement on terminology can affect access to services, recommended "developmental language disorder" as the term for language disorders with no known biomedical cause.[2]
Labels can also change with your child's age and setting. In a 2020 article, researcher Karla McGregor explains that "In U.S. schools, younger children with language concerns likely qualify for services under the category of 'developmental delay,' whereas older children will qualify under the category of 'speech-language impairment' or, in some cases, 'specific learning disability.'"[4] She writes that "It is essential to help parents understand the diversity of labels that may apply to their child in various settings and at various times."[4] So if your child's school paperwork uses a different term than a private evaluation report, that alone doesn't mean anyone is wrong.
How common is DLD?
More common than many parents would guess. NIDCD calls DLD "one of the most common developmental disorders, affecting approximately 1 in 14 children in kindergarten."[1] A large population study of children starting school in England estimated the prevalence of "language disorder of unknown origin" at 7.58%, and concluded that "approximately two children in every class of 30 pupils will experience language disorder severe enough to hinder academic progress."[3] McGregor points out that, at that estimate, DLD is "nearly 7 times more common than autism spectrum disorder."[4]
What are the signs of DLD?
NIDCD notes that "A child with DLD often has a history of being a late talker," and that "Although some late talkers eventually catch up with peers, children with DLD have persistent language difficulties."[1] (Our post on late talkers covers the toddler years.)
According to NIDCD, younger children with DLD may:[1]
- "Be late to put words together into sentences."
- "Struggle to learn new words and make conversation."
- "Have difficulty following directions, not because they are stubborn, but because they do not fully understand the words spoken to them."
- "Make frequent grammatical errors when speaking."
In older children and adults, NIDCD lists signs such as "Limited use of complex sentences," "Difficulty finding the right words," "Difficulty understanding figurative language," "Reading problems," "Disorganized storytelling and writing," and "Frequent grammatical and spelling errors."[1]
One sign is easy to miss: NIDCD warns that "Language difficulties may be misinterpreted as a behavioral issue." A child who struggles with language "may avoid interactions, leading others to think that the child is shy," or may not follow directions "because they don't understand the instructions, but others may interpret this as misbehavior."[1]
Only a professional evaluation can tell you whether these signs point to DLD or to something else, so treat this list as a reason to ask questions, not as a checklist for diagnosis.
Why is DLD so easy to miss?
McGregor calls DLD "a hidden impairment." She writes, "For the most part, children with DLD do not sound unusual; they may seem younger than they are, but not unusual. By the time they reach school, most can carry on a basic conversation, follow a simple command, and answer a routine question."[4] She adds that parents, while "experts about their children," are "not reliable at judging whether their elementary-aged child's language development is on track relative to that of other children," and that in many cases "neither are teachers."[4]
Her article also describes how often it goes unrecognized. In one U.S. study she summarizes, even among the children with the lowest scores, "only 39% of them had ever been identified as having language deficits."[4]
From NIDCD: "When a child is struggling at home or in school, it is important to determine if language difficulties may be part of the problem."[1]
What causes DLD? Did we do something wrong?
No one knows exactly. NIDCD explains that "DLD is a neurodevelopmental disorder" and that "The exact causes of the brain differences that lead to DLD are unknown." It notes that DLD tends to run in families: "50 to 70 percent of children with DLD have at least one family member with the disorder."[1]
Bilingual families often ask whether two languages caused the problem. NIDCD is clear: "Learning more than one language at a time does not cause DLD," and "learning multiple languages is not harmful for a child with DLD." It also notes that for multilingual children, "DLD will impact all languages spoken by a child."[1] Our post on raising a bilingual child has more on this.
Can a child have DLD and something else, like ADHD?
Yes. The expert panel concluded that "DLD can co-occur with other neurodevelopmental disorders (e.g. ADHD)," that "DLD does not require a mismatch between verbal and nonverbal ability," and that the "presence of risk factors (neurobiological or environmental) does not preclude a diagnosis of DLD."[2] In other words, a child doesn't need to have otherwise "average" test scores, or a clean history, for DLD to be considered. The population study came to a similar view, concluding that "Access to specialist clinical services should not depend on NVIQ" (nonverbal IQ).[3]
Will my child grow out of it?
DLD usually changes over time rather than disappearing. NIDCD says the developmental label "does not mean that, as children develop, they grow out of the problem. Instead, the condition is apparent in early childhood and will likely continue, but change, as they get older."[1] The expert panel similarly noted that "Language problems that are still evident at 5 years and over are likely to persist."[2]
That matters for school. NIDCD explains that "DLD is not the same thing as a learning disability," but that it "is a risk factor for learning disabilities since problems with basic language skills affect classroom performance." It reports that by adulthood, "people with DLD are six times more likely to be diagnosed with reading and spelling disabilities."[1] If reading is a worry, our reading and literacy page explains how language and reading connect.
How is DLD diagnosed and treated?
According to NIDCD, "a speech-language pathologist (a professional trained to assess and treat people with speech or language problems) can evaluate the child's language skills." An evaluation generally includes "Direct observation of the child," "Interviews and questionnaires completed by parents and/or teachers," "Assessments of the child's learning ability," and "Standardized tests of current language performance."[1] You can read about what a private assessment involves on our speech and language evaluations page.
NIDCD notes that "Treatment services for DLD are typically provided or overseen by a licensed speech-language pathologist," and that "Identifying and treating children with DLD early in life is ideal, but people can benefit from treatment regardless of when it begins." For school-age children, it says treatment may focus on things like "Following directions," "Understanding the meaning of the words that teachers use," "Organizing information," and "Improving speaking, reading, and writing skills."[1] Every child's needs and progress are different.
It's also fine to ask for the name. McGregor notes that "Parents report that they want a diagnostic label," because "They feel better able to understand and to explain childhood language disorder to others."[4] If your child was evaluated at school and didn't qualify for services, that page explains some of the options families consider.
The bottom line
Developmental language disorder affects how children understand and use language, and it's far more common than its low profile suggests: roughly 1 in 14 kindergartners, according to NIDCD. Because children with DLD often sound fairly typical in everyday conversation, it can be mistaken for shyness, inattention, or misbehavior. It isn't caused by parenting or by learning two languages, and it tends to change over time rather than simply going away. If you have concerns about how your child understands, talks, reads, or writes, talk with your pediatrician or a speech-language pathologist, who can look at your child as an individual.
Sources
- National Institute on Deafness and Other Communication Disorders (n.d.). Developmental Language Disorder. NIDCD, National Institutes of Health.
- Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & the CATALISE-2 consortium (2017). Phase 2 of CATALISE: A multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology. Journal of Child Psychology and Psychiatry (via PubMed Central).
- Norbury, C. F., Gooch, D., Wray, C., Baird, G., Charman, T., Simonoff, E., Vamvakas, G., & Pickles, A. (2016). The impact of nonverbal ability on prevalence and clinical presentation of language disorder: Evidence from a population study. Journal of Child Psychology and Psychiatry (via PubMed Central).
- McGregor, K. K. (2020). How We Fail Children With Developmental Language Disorder. Language, Speech, and Hearing Services in Schools (via PubMed Central).
Articles from Speech Me Therapy, a pediatric speech-language therapy practice in North Phoenix serving Scottsdale, Paradise Valley, and families across Arizona by telehealth. Our posts summarize published guidance from professional and public health organizations; sources are listed at the end of every article.