1. How is specific language impairment identified?
Dorothy V M Bishop

2. Specific language impairment (SLI)
Identified in children when language development falls well behind that of other children of the same age
Problems interfere with everyday life and school achievement
Not due to hearing loss, physical abnormality, acquired brain damage, lack of language experience
Not part of a general developmental delay

3. The first step
Child comes to attention because a parent, caregiver or teacher recognises a problem, such as:
Doesn’t talk much
Language seems immature for age
Struggles to find words
Doesn’t seem to understand what is said
In older children, may fail to understand written language

4. N.B. Be aware that… Language problems are not always obvious.
Language difficulties may underlie problem behaviour such as:
Anxiety in social situations
Bad behaviour in class
Inattention
Failure to obey instructions
Problems with peer group
Academic problems (esp. poor reading/writing)
Cohen, N. J. (1996). Unsuspected language impairments in psychiatrically disturbed children: developmental issues and associated conditions. In J. H. Beitchman, N. J. Cohen, M. M. Konstantareas & R. Tannock (Eds.), Language, Learning, and Behavior Disorders (pp ). Cambridge: Cambridge University Press.

5. Three strands to assessment
Information from parents/caregivers/teachers
Direct observation of the child in a natural setting
Formal assessment using standardized tests

6. Information from parents and others who know the child
May be seen initially by paediatrician, speech and language therapist, or educational psychologist, who will take a case history
Useful if parent or teacher can give specific examples of how the child communicates and can describe occasions when child’s language problems have been an issue
Need to know what motivates the child to communicate and how communication is achieved – e.g. does the child use gesture/pointing
Can he/she follow simple verbal instructions out of context?
Can he/she understand a story, or talk about something in the past in a coherent sequence?
Bishop, D., & Norbury, C. F. (2008). Speech and language disorders. In M. Rutter, D. Bishop, D. Pine, S. Scott, J. Stevenson, E. Taylor & A. Thapar (Eds.), Rutter's Child and Adolescent Psychiatry (pp ). Oxford: Blackwell.

7. Standardized approaches to parental report
Parental report may be obtained by a standardized interview such as the Vineland Adaptive Behaviour Scales (which also assesses other domains)
The Children’s Communication Checklist-2 is useful for screening for language problems and identifying particular types of difficulty
Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior Scales: Second Edition (Vineland II), Survey Interview Form/Caregiver Rating Form. Livonia, MN: Pearson Assessments.
Bishop, D. V. M. (2003). The Children's Communication Checklist, version 2 (CCC-2). London: Pearson.

8. Direct observation of the child
Clinician may observe how the child communicates with a parent
For those at school, it can be informative to observe the child interacting with other children in the classroom
The focus will be on the language used by the child, the extent to which the child appears to understand what others say, and whether the child uses nonverbal means of communication, such as gesture and facial expression

9. Standardized assessments
A standardized assessment is one that has been given to a large group of children of different ages, to establish the normal range of performance.
Test scores are often reported as percentiles, which indicate the percentage of people obtaining a score at a given level or below.
A score at the 50th percentile is average for age – half the population would be expected to get a score lower than that
A score at the 10th percentile would mean one in 10 children would get a score as low
Common cutoffs for disorder: either 16th percentile or 10th percentile

10. Test scores and language impairment
Scores are not set in stone: a child’s performance may vary depending on how they feel on the day
In general, language impairment would not be identified on the basis of a single language test
It’s more usual to give a collection of assessments that look at different aspects of language, and then to consider the overall profile

11. EpiSLI criteria EXPRESSIVE RECEPTIVE Vocabulary Grammar Narrative
Vocabulary composite
Grammar composite
Narrative composite
Expressive composite Receptive composite
Total of 6 tests, giving 5 composites
Language impairment: 10th percentile or lower on 2+ language composites
Tomblin, J. B., Records, N. L., Buckwalter, P., Zhang, X., Smith, E., & O'Brien, M. (1997). Prevalence of specific language impairment in kindergarten children. Journal of Speech and Hearing Research, 40(6),

12. Limitations of test scores
Test scores have advantage of being reasonably objective; standardized tests have strict instructions on administration and scoring
But some aspects of communication not easy to capture on tests
Also, should we worry about a child who gets low test score if neither teachers or parents are concerned?
In Tomblin et al study, only 29% of children meeting EpiSLI criteria enrolled in intervention

13. Combining test scores and parental report
Parental checklist, CCC-2, identifies different subset of children than standardized tests
Children identified by parental checklist do have academic problems, so seems parental report is important
May be best to combine both sources of information: standardized tests and parental report
Bishop, D. V. M., & McDonald, D. (2009). Identifying language impairment in children: combining language test scores with parental report. International Journal of Language and Communication Disorders, 44,

14. Assessing nonverbal abilities
Children with SLI often have additional problems, especially with attentional skills and motor skills
However, they are usually distinguished from children who have a generalised cognitive impairment by the fact that they have normal range nonverbal ability
Assessment of nonverbal ability is done using a standardized test that looks at ability to reason using shapes and pictures.

15. Debate over nonverbal ability
Some formal definitions of specific language impairment, such as the one in the International Classification of Diseases – 10, require that a child has a substantial gap (1 SD or more) between their nonverbal ability and language ability
This has been criticised on several counts:
Very few children meet that criterion
A child’s response to treatment doesn’t depend on whether they have a big or small gap between language and nonverbal ability
Twin studies do not support the idea of a language-nonverbal gap as defining a coherent group with a common genetic basis
Bishop, D. V. M. (2004). Specific language impairment: diagnostic dilemmas. In L. Verhoeven & H. Van Balkom (Eds.), Classification of Developmental Language Disorders (pp ). Mahwah, NJ.: Erlbaum.

16. EpiSLI criteria (Tomblin et al)
SLI definition requires normal range nonverbal ability, but does not require large gap with language. Also studied children with Nonspecific LI, with low language/nonverbal scores
Specific language impairment (SLI):
score at/below 10th percentile or lower on two or more language composites
19th percentile or above on nonverbal IQ
Non-specific language impairment (NLI):
below 19th percentile on nonverbal IQ
These two groups vary in severity, and the SLI group has better outcome.
But overall, differences are a matter of degree; few qualitative differences

17. Terminology Speech, language and communication needs SLI =
Developmental dysphasia =
Specific developmental
language disorder =
Primary language
impairment