Specific language impairment: a convenient label for whom?

Abstract

Background: The term 'specific language impairment' (SLI), in use since the 1980s, describes children with language impairment whose cognitive skills are within normal limits where there is no identifiable reason for the language impairment. SLI is determined by applying exclusionary criteria, so that it is defined by what it is not rather than by what it is. The recent decision to not include SLI in DSM-5 provoked much debate and concern from researchers and clinicians. Aims: To explore how the term 'specific language impairment' emerged, to consider how disorders, including SLI, are generally defined and to explore how societal changes might impact on use the term. Methods & Procedures:We reviewed the literature to explore the origins of the term 'specific language impairment' and present published evidence, as well as new analyses of population data, to explore the validity of continuing to use the term. Outcomes & Results and Conclusions & Implications:We support the decision to exclude the term 'specific language impairment' from DSM-5 and conclude that the term has been a convenient label for researchers, but that the current classification is unacceptably arbitrary. Furthermore, we argue there is no empirical evidence to support the continued use of the term SLI and limited evidence that it has provided any real benefits for children and their families. In fact, the term may be disadvantageous to some due to the use of exclusionary criteria to determine eligibility for and access to speech pathology services. We propose the following recommendations. First, that the word 'specific' be removed and the label 'language impairment' be used. Second, that the exclusionary criteria be relaxed and in their place inclusionary criteria be adopted that take into account the fluid nature of language development particularly in the preschool period. Building on the goodwill and collaborations between the clinical and research communities we propose the establishment of an international consensus panel to develop an agreed definition and set of criteria for language impairment. Given the rich data now available in population studies it is possible to test the validity of these definitions and criteria. Consultation with service users and policy-makers should be incorporated into the decision-making process.

Children with Language Impairment: Prevalence, Associated Difficulties, and Ethnic Disproportionality in an English Population

“…The reasons for the use of SLI as a diagnostic category, both for research and practice, and the limitations of this approach have recently been critically reviewed by Bishop (2014) and Reilly et al (2014b) in a special issue of the International Journal of Language and Communication Disorders, which also included responses from other experts and a joint paper setting out proposals for further developments (Reilly et al, 2014a). Together, these reviews present a substantial critique of the validity and usefulness of SLI as a diagnostic category, supporting the decision to exclude this category from the DSM-5, the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013); but, see also Rice (2016) for a contrary review supporting the usefulness of SLI as a diagnostic category.…”

“…These criteria include social disadvantage, episodes of otitis media, anomalies of the oral structure and oral motor function, being bilingual, and autism spectrum disorders [ASD: see Bishop (2014)]. Similarly, Reilly et al (2014b) argue for a lack of support for inclusionary criteria of biological (neural and genetic) markers, clinical behavioral markers, and differentiated profiles and outcomes of children with SLI compared to children with non-specific impairments. Furthermore, there is a lack of consistency in the use of different terms for children with language difficulties as used by practitioners and researchers (Dockrell et al, 2006).…”

Two-Year Outcomes of a Population-Based Intervention for Preschool Language Delay: An RCT

“…In a recent review of specific language impairment, we suggested that eligibility should only be determined once a child's performance has been monitored over time, possibly for a full 12 months. 32 Many if not most of the children who participated in this study would have been ineligible under this stricter criterion.…”

Distinguishing cause from effect – many deficits associated with developmental dyslexia may be a consequence of reduced and suboptimal reading experience

“…It has even been suggested that developmental dyslexia and specific language impairment are points on a continuum of learning disorders rather than distinct disabilities (Kamhi & Catts, 1986;cf. Tallal, Allard, Miller, & Curtiss, 1997; but see Bishop & Snowling, 2004;Norbury, 2014;Reilly, Bishop, & Tomblin, 2014).…”