A speech and language pathologist diagnoses language disorder after a comprehensive examination. This includes talking to parents about heredity (genetic factors/family history) and earlier development, testing of various linguistic areas (speech sounds, syntax, words/concepts, pragmatics) mapping of the child’s environment and exclusion of physical factors. Speech and language pathologists in Sweden currently diagnose according to ICD-10 (WHO), but there is a beta version of ICD-11 available at https://icd.who.int/browse11/l-m/en. The purpose of the diagnosis is to provide information about the child’s linguistic profile and needs, as well as predict what kind of issues they might face later in life.
Often, many speech and language pathologists work “on their own” at hospitals or in primary care services, but in other contexts – e.g. in habilitation, neuropsychiatric or child and adolescent psychiatric services – they are part of a team.
When assessing verbal and non-verbal communication and social interaction, i.e. pragmatic skills, it is crucial to include observations of everyday situations, for example play activities that both elicit and elucidate communicative intentions. If any pragmatic abnormalities are found, one should move on to a more thorough investigation of the child’s communication and interaction skills and general developmental level.
In the beta version of ICD-11 (January 2020), under the heading Neurodevelopmental disorders, it is proposed that the category Developmental speech or language disorders should be divided into:
Developmental speech sound disorder (SSD) and Developmental language disorder (DLD).
• SSD includes difficulties with speech sounds/articulation and excludes deafness, neurological disorders and dysarthria.
• DLD includes difficulties in acquiring, comprehending, producing or using language, typically with onset in early childhood. The person’s level of comprehension, production or use of language is markedly below their expected level based on age and overall intellectual functioning. The language difficulties cannot be explained by any other neurodevelopmental or sensory impairment or neurological condition, including brain injury or infection. DLD excludes ASD, neurological disorders, deafness, selective mutism.
Clinically speaking, we know that many preschool/school-age children simultaneously struggle with other cognitive difficulties as well, and that all these issues can be difficult to tell apart. For example, difficulties relating to concentration/attention, motor control, reading, communication and behaviour do not preclude a diagnosis of DLD. However, DLD is not used if the language disorder is associated with other diagnoses, such as ASD. These cases are instead referred to as language disorder, LD, associated with… This may seem quite remarkable considering that many children with autism also have language difficulties and that DSM-5 (the classification most commonly used in child neuropsychiatric services) states that both linguistic and cognitive level should be specified in children with autism.