Ten questions about terminology for children with unexplained language problems

Abstract

Background: In domains other than language, there is fairly consistent diagnostic terminology to refer to children's developmental difficulties. For instance, the terms 'dyslexia', 'attention deficit hyperactivity disorder' and 'autistic spectrum disorder' are used for difficulties with reading, attention or social cognition, respectively. There is no agreed label, however, for children with unexplained language problems.

Aims: To consider whether we need labels for unexplained language problems in children, and if so, what terminology is appropriate.

Main contribution: There are both advantages and disadvantages to labels, but they are important to ensure children receive services, and to increase our knowledge of the nature and causes of such problems. A survey of labels in current use found 132 different terms, 33 of which had 600 or more returns on Google Scholar between 1994 and 2013. Many of these labels were too general to be useful. Of the remainder, the term 'specific language impairment' was the most commonly used.

Conclusions: The current mayhem in diagnostic labels is unsustainable; it causes confusion and impedes research progress and access to appropriate services. We need to achieve consensus on diagnostic criteria and terminology. The DSM-5 term 'language disorder' is problematic because it identifies too wide a range of conditions on an internet search. One solution is to retain specific language impairment, with the understanding that 'specific' means idiopathic (i.e., of unknown origin) rather than implying there are no other problems beyond language. Other options are the terms 'primary language impairment', 'developmental language disorder' or 'language learning impairment'.

Keywords: DSM-5; diagnosis; labels; specific language impairment; terminology.

Figure 1

Causal model in which there is a direct link from communicative behaviour in the parents to language impairment in the child.

Figure 2

Causal model in which shared genes account for association between socioeconomic factors in the parents and language impairment in the child.

Figure 3

Relationship between social communication disorder (SCD), specific language impairment (SLI) and autism spectrum disorder (ASD) in DSM-5. Unlabelled regions of the Venn diagram do not correspond to specific diagnostic labels, though it is likely that some children would fall in these regions.

Figure 4

Possible terminology for children with unexplained language problems: 130 of the 168 possible combinations of a prefix, descriptor and noun were found on a literature search using Google Scholar.