Thoughts of a secondary school SLT

Category: Language disorders

  • What makes sentences complicated?

    Preadolescents and adolescents with language disorders struggle to understand the types of sentences they are exposed to at secondary school. Academic language, or informational language is characterized by long, complex sentences and technical vocabulary, used to express higher level ideas (for more information about this type of language, see my blog post: https://secondaryschoolslt.wordpress.com/2026/04/15/what-is-expository-discourse-and-how-is-it-relevant-at-secondary-school/).

    Many students with Developmental Language Disorder (DLD) have restricted vocabularies which impede their understanding of this type of language. They are also likely to have weaker, or nonexistent knowledge of certain grammatical structures that cause no problems for their peers, such as passives and object relative clauses (Scott, 2009, Montgomery et al, 2021).

    However, not even their typically developing peers can be expected to understand all of the sentences they come across at this age, since not all adults achieve complete mastery of certain sentence structures. For example, in one study, Nippold et al (2020) found that only 25% of the supposedly typical young adults in their sample were able to produce past tense counterfactual (PTCF) sentences perfectly, and only 50% were able to understand them all the time.

    Aspects other than linguistic knowledge also affect our understanding of such sentences. For example, Leonard et al (2007) found that 62% of the variance in children’s composite language scores was down to nonlinguistic factors, such as Verbal Working Memory (VWM) and processing speed.

    According to Balthazar and Scott (2023, p.567), “syntactic complexity carries a processing cost for all speakers across all modalities”. You might imagine that written language would be less affected by factors such as VWM than oral language which must be interpreted in the moment. However, this has not been found to be the case, probably because the reader still has to use their inner voice to “re-auditorise” the sentence and move parts around.

    Researchers such as Scott, Balthazar and Nippold have spoken in detail about exactly what makes sentences more complex and harder to process. Scott (2009) highlights factors such as the number propositions and embeddings, the sentence order as well as the distance between the main elements. In a later article, Balthazar and Scott (2023, p. 565) defined sentence complexity as “any structure that adds to, interrupts, or changes the subject–verb–object (SVO) order within a clause or adds clauses within a sentence and can be reasonably predicted to increase the processing “load” of the sentence”.

    Firstly, then, a long sentence made up of multiple clauses is harder to process than a simple sentence made up of just one main clause. By definition, a sentence becomes “compound” or “complex” when coordinated or subordinate clauses are added. Syntactic complexity is not just about the length of the sentence, but also the “clausal density” or “subordination index”; in other words, the average number of clauses per sentence.

    Similarly, it is not just about the number of clauses, but how they are arranged. Academic text tends to feature “different levels of subordination” to express a hierarchy of ideas. Conjunctions such as “unless”, “despite” and “otherwise” are used to give weight to certain ideas over others and are capable of expressing subtle relationships between different parts of a sentence.

    This contrasts with oral, conversational language where conjoined clauses of equal value connected with simple conjunctions such as “and”, “but” and “so” are more common (see my post: https://secondaryschoolslt.wordpress.com/2026/04/06/how-are-oral-and-written-language-different/  for more about the differences between oral and written language).

    A particularly complex form of subordination is called “embedding”, where one clause is placed within another, and acts as a noun or adjective in that sentence. Central embedding is considered particularly difficult to understand, and “nesting”, where one clause is placed within another within another even more so. When this exceeds three levels, the sentence quickly becomes unintelligible, e.g. “the dog the cat the mouse bit chased barked”.

    Syntactic complexity can also be increased through elaboration of noun and verb phrases. In one study, Leonard et al (2013) found that when adjectives were added to different nouns, e.g. “the happy yellow dog washes the little pig”, children with language disorders quickly became confused about who was the agent and who was the patient (Leonard et al, 2013, p. 12).

    Cheryl Scott (2009, p. 186) also compares the simple sentence “the amendment was a disaster” with the more complex sentence, “the thoroughly rewritten and meaningless amendment that was inserted by the aide was a disaster.”  Whilst both sentences contain the same subject, amendment, the second has been expanded through the use of modifiers which come before the noun, “pre-modifying” it, as well as a relative clause which comes afterwards, “post-modifying” it.

    Sentences such as this, where a large amount of information precedes the main verb, can also be referred to as “left-branching”. According to Marilyn Nippold (2023, p.44), the entire noun phrase must be held in working memory until the reader/ listener reaches the main action, “was a disaster” and finds out what the sentence is about, increasing processing demands. Other structures which may feature in left branching sentences include adverbial clauses, prepositional phrases and appositives.

    English is also a language with a strict subject-verb-object (SVO) order, and anything which disrupts this is thought to make sentences harder to understand. As mentioned, pre- and post-modification of the noun phrase can do this by creating gaps (long distance dependencies) between elements which are typically close together. However, any sentence which is not in canonical (typical) order, such as passives and clefts (Scott and Balthazar, 2013) may cause difficulties, since certain elements need to be moved around in the mind.

    One further point is that students with DLD may also be overly reliant on immature comprehension strategies such as order-of-mention and context cues. Referring back to the last example sentence, a student with a language disorder may mistakenly connect the predicate “was a disaster” with the immediately preceding noun, “aide”, leading them to the conclusion that the aide was the disaster rather than the amendment. This mistake of believing the nearest noun to be the subject of the sentence is not uncommon (Scott, 2009, Scott and Balthazar, 2013).

    Finally, studies have shown that sentence complexity impacts working memory performance differently across different languages. In English, syntactic complexity had the greater impact, whilst in Hungarian, it was the increased morphological complexity of words (Kail and Csépe, 2006). This is likely due to the distinguishing features of the different languages.

    To sum up, some sentences are so complex that they challenge the processing limits of any listener or reader. As students progress through secondary school and beyond, they are increasingly exposed to this type of academic language. Knowing exactly what can make sentences hard to understand, for all of us, not just those with language disorders will make it easier for us to support our students.

    Notes

    Balthazar, Catherine H., and Cheryl M. Scott. “Sentences Are Key.” American Journal of Speech-Language Pathology 33, no. 2 (2023): 564–579.

    Kail, Michèle, Valéria Csépe, F. L. C. C. 2006. “Effects of Sentence Length and Complexity on Working Memory Performance in Hungarian Children with Specific Language Impairment: A Cross-Linguistic Comparison.” [International Journal of Language & Communication Disorders] 41, no. 6: 713-731.

    Leonard, Laurence B., Patricia Deevy, James W. Miller, Chrystal Rameela, Robert Schwartz, and J. Bruce Tomblin. “Speed of Processing, Working Memory, and Language Impairment in Children.” Journal of Speech, Language, and Hearing Research 50, no. 2 (April 2007): 408–428. 

    Leonard, Laurence B., Patricia Deevy, Marc E. Fey, and Shelley L. Bredin-Oja. “Sentence Comprehension in Specific Language Impairment: A Task Designed to Distinguish between Cognitive Capacity and Syntactic Complexity.” Journal of Speech, Language, and Hearing Research 56, no. 3 (June 2013): 937–949.

    Montgomery, James W., Ronald B. Gillam, and Julia L. Evans. “A New Memory Perspective on the Sentence Comprehension Deficits of School-Age Children With Developmental Language Disorder: Implications for Theory, Assessment, and Intervention.” Language, Speech, and Hearing Services in Schools 52, no. 2 (April 2021): 449–466.

    Nippold, Marilyn A., Abigail Nehls-Lowe, and Daemion Lee. “Development of Past Tense Counterfactual Sentences: Examining Production and Comprehension in Adolescents and Adults.” Journal of Speech, Language, and Hearing Research 63, no. 10 (October 2020): 3474–3484.

    Nippold, M.A. (2023). Grammar guide for speech-language pathologists: Steps to analyzing complex syntax. San Diego: Plural Publishing.

    Scott, Cheryl M. “A Case for the Sentence in Reading Comprehension.” Language, Speech, and Hearing Services in Schools 40, no. 2 (2009): 184-191.

     Scott, Cheryl M., and Catherine H. Balthazar. “The Grammar of Information: Challenges for Older Students With Language Impairments.” Topics in Language Disorders 30, no. 4 (2010): 288–307.

    Scott, Cheryl M., and Catherine Balthazar. “The Role of Complex Sentence Knowledge in Children with Reading and Writing Difficulties.” Perspectives on Language and Literacy 39, no. 3 (Summer 2013): 18–3

  • Is poor working memory the cause of comprehension difficulties in older students with language disorders?

    Students with language disorders have difficulties that extend beyond language. There is an extensive research literature linking weaknesses in broader cognitive skills such as attention, processing speed, executive functioning, short term and working memory with language disorders (Leonard et al, 2007, 2013, Henry and Botting, 2017).

    Short term and working memory have received particular attention. Whilst some studies have identified weaknesses in the nonverbal component, suggestive of domain-general impairments in this population, deficits in verbal short term memory (VSTM) and verbal working memory (VWM) have been more consistently reported, and found to be 2-3 times larger (Vugs et al, 2013). What’s more, poor performance on nonword repetition tasks, widely used to test VSTM, is even considered a clinical marker for Developmental Language Disorder (DLD) (Bishop et al, 2016).

    VSTM and VWM are often used interchangeably, but VSTM might be more accurately considered a component of VWM. VSTM refers to the ability to hold information just heard in mind for a short period of time before it “decays” and has historically been thought of as a “storage space” with limited capacity. Indeed, most people are only able to keep three or four chunks of information in their heads at once (Montgomery et al, 2021).

    Meanwhile, VWM involves manipulation as well as storage of information, and is increasingly being thought of more as a “mental workspace”. Others have spoken of VWM in terms of a set of cognitive processes that include sustained attention, inhibition of irrelevant information, and the ability to switch simultaneously between maintenance of stored information and processing new information (Marton et al, 2007, Leonard et al, 2013).

    Various theories of working memory have been proposed in the past, one of the most influential being Baddeley and Hitch’s multicomponent model, made up of two passive storage systems: the “phonological loop” (or VSTM) and “visuo-spatial sketchpad”, as well as a “central executive” and “episodic buffer” (Baddeley and Hitch, 1974, Baddeley, 2000).

    According to this, the phonological loop stores speech-based and verbal information (and could be considered what we refer to as VSTM). Whilst information typically fades away after a couple of seconds, it is possible to keep it in an active state for longer through silent repetition (such as when you repeat a phone number or code to yourself). The visuospatial sketchpad stores visual information in a similar fashion, whilst the central executive acts as the control centre, dividing and switching attention between different tasks. Meanwhile, the episodic buffer binds the information together, and acts as an interface between short and long-term memory.

    VSTM and VWM are considered essential to learning in the classroom, from following lengthy instructions and understanding what’s going on in lessons, to keeping the steps of a task in mind and recalling the details of a story. Working memory has been found to be a more powerful predictor of academic achievement even than IQ (Alloway and Alloway, 2010). Students with poor VWM may appear inattentive, forgetful or careless, when really they are struggling to retain what was said.

    VWM is also considered to be intrinsically linked to comprehension of complex sentences, since certain elements have to be kept in mind, and even moved around whilst the next part is processed. Long, complex sentences require more processing time than simple sentences, and are not as easily understood (e.g. Marton et al, 2007), suggesting that increased VWM capacity is required to understand such sentences. Montgomery et al (2009) argued that comprehension of both simple and complex grammar is a mentally demanding task for school age children with and without language disorders that requires significant working memory resources.

    Other authors such as Balthazar and Scott (2023) have spoken at length about the various elements that can increase the processing “load” of a sentence. This includes the number of clauses, long distance dependencies (gaps), as well as (in English) anything that disrupts the subject-verb-object order such as passive constructions and post-modification of the noun phrase (see my post for more information).

    Take the following example sentence given by Marilyn Nippold (2010) from a science text book: “organisms that eat living corals, such as the crown-of-thorns sea star, can greatly damage reefs”. In this sentence, post-modification of the noun “organisms” with the phrase “that eat living corals, such as the crown-of-thorns sea star” results in an extended gap between the main subject and verb. This whole phrase must then be stored in VSTM (or the phonological loop according to the Baddeley model) until the reader reaches the main action, “can greatly damage” and understands what the sentence is about.

    For a student with a language disorder and limited VWM, this is likely to be challenging. Other studies have shown that adolescents with DLD do not understand complex sentences as well as their typically developing peers, despite similar performance for simple sentences (Montgomery et al, 2009). Some researchers have even gone so far as to argue that VWM difficulties, rather than poor language knowledge are the primary cause of receptive language difficulties in older students (Larson and McKinley, 2003).

    However, recent research suggests that the reality may be more complex. Indeed, there is some evidence to suggest that complex sentences are processed in different ways by those with and without language disorders, with working memory playing an unequal role in each. In a large scale study of 117 children with DLD and 117 typically developing peers aged 7-11, Montgomery et al (2021) investigated how a range of measures were connected with comprehension of simple and more complex sentences.

    They found that fluid reasoning and language knowledge residing in long-term memory (LTM) indirectly influenced comprehension of complex, non-canonical sentences in typically developing students. For those with DLD, on the other hand, controlled attention (an important facet of working memory), was more important (Montgomery et al, 2021).

    On the back of this research, they came up with a new memory model, the GEM (Gillam-Evans-Montgomery) model, where VWM serves as a conduit for fluid reasoning, controlled attention and long-term language knowledge. They argued that listeners face the challenge of a rapid incoming stream of speech in different ways (Montgomery et al, 2021).

    According to them, repeated experience with language allows most people to build up linguistic representations in long-term memory (LTM). Typically developing listeners are able to activate these patterns, some of which may take the form of multiword templates, to anticipate the types of words that are likely to come next, as well as to “chunk” the speech stream into noun phrases, verb phrases and even whole clauses. This information is then stored as chunks, reducing the demands on working memory capacity, before being reintegrated into a coherent whole (Montgomery et al, 2021).

    They hypothesized that students with DLD may have weaker, or non-existent representations of certain grammatical structures. This means that they will be unable to segment the speech stream in the same way as their peers, resulting in word by word processing which places enormous pressure on an already overstretched VWM. Accordingly, sentence processing is much more effortful for those with language disorders (Montgomery et al, 2021).

    This theory seems to be backed up by a review of the literature. Karavasilis et al (2023) found inconclusive evidence of a link between VSTM/ VWM and complex sentence comprehension in typically developing individuals. On the other hand, there was a consistent link between working memory and sentence comprehension in those with DLD. The authors concluded that, at least for children with DLD, a processing component is involved in comprehension of complex sentences.

    According to Montgomery et al (2021), the solution is not to attempt to improve students’ VWMs (which, in any case, has had limited success), but rather, to support their language representations in long-term memory.

    Notes

    Alloway, Tracy Packiam, and Ross G. Alloway. “Investigating the Predictive Roles of Working Memory and IQ in Academic Attainment.” Journal of Experimental Child Psychology 106, no. 1 (May 2010): 20–29.

    Baddeley, Alan D., and Graham J. Hitch. 1974. “Working Memory.” In The Psychology of Learning and Motivation: Advances in Research and Theory, edited by Gordon H. Bower, Vol. 8, 47–89. New York: Academic Press.

    Baddeley, A.D. (2000). The episodic buffer: A new component of working memory? Trends in Cognitive Sciences, 4, 417-423.

    Baddeley, Alan. 2003. “Working Memory: Looking Back and Looking Forward.” Nature Reviews Neuroscience 4, no. 10: 829–39.

    Balthazar, Catherine H., and Cheryl M. Scott. “Sentences Are Key.” American Journal of Speech-Language Pathology 33, no. 2 (2023): 564–579.

    Bishop DVM, Snowling MJ, Thompson PA, Greenhalgh T, CATALISE consortium (2016)

    CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children. PLoS ONE 11(7): e0158753. doi:10.1371/journal.pone.0158753

    Haebig, Eileen, Christine Weber, Laurence B. Leonard, Patricia Deevy, and J. Bruce Tomblin. “Neural Patterns Elicited by Sentence Processing Uniquely Characterize Typical Development, SLI Recovery, and SLI Persistence.” Journal of Neurodevelopmental Disorders 9, no. 1 (2017): 22.

    Henry, L. & Botting, N. (2017). Working memory and developmental language impairments. Child Language Teaching and Therapy, 33(1), pp. 19-32.

    Karavasilis, Gavriil, K. Diakogiorgi, and D. Papadopoulou. 2023. “The Role of Working Memory in the Comprehension of Syntactically Complex Sentences in Children with and without Developmental Language Disorder: A Literature Review.” Psychology: The Journal of the Hellenic Psychological Society 28 (2): 205–222.

    Larson, V.L. and McKinley, N.L. (2003) Communication solutions for older students. Thinking Pub. 

    Leonard, Laurence B., Patricia Deevy, James W. Miller, Chrystal Rameela, Robert Schwartz, and J. Bruce Tomblin. “Speed of Processing, Working Memory, and Language Impairment in Children.” Journal of Speech, Language, and Hearing Research 50, no. 2 (April 2007): 408–428. 

    Leonard, Laurence B., Patricia Deevy, Marc E. Fey, and Shelley L. Bredin-Oja. “Sentence Comprehension in Specific Language Impairment: A Task Designed to Distinguish between Cognitive Capacity and Syntactic Complexity.” Journal of Speech, Language, and Hearing Research 56, no. 2 (April 2013): 577-589.

    Marton, Klara, Richard G. Schwartz, Lajos Farkas, and Valeriya Katsnelson. “Effect of Sentence Length and Complexity on Working Memory Performance in Hungarian Children with Specific Language Impairment: A Cross-Linguistic Comparison.” International Journal of Language & Communication Disorders 42, no. 6 (2007): 691–711.

    McCauley, Stewart M., and Morten H. Christiansen. 2015. “Individual Differences in Chunking Ability Predict On-line Sentence Processing.” In Proceedings of the 37th Annual Conference of the Cognitive Science Society, edited by D. C. Noelle et al., 1550–1555. Austin, TX: Cognitive Science Society. 

    Montgomery, James W., and Julia L. Evans. 2009. “Complex Sentence Comprehension and Working Memory in Children with Specific Language Impairment.” Journal of Speech, Language, and Hearing Research 52, no. 2 (April): 269-288.

    Montgomery, James W., Ronald B. Gillam, and Julia L. Evans. “A New Memory Perspective on the Sentence Comprehension Deficits of School-Age Children With Developmental Language Disorder: Implications for Theory, Assessment, and Intervention.” Language, Speech, and Hearing Services in Schools 52, no. 2 (April 2021): 449–466.

    Newman, Sharlene D., Evie Malaia, Roy Seo, and Hu Cheng. “The effect of individual differences in working memory capacity on sentence comprehension: an fMRI study.” Brain and Language 125, no. 3 (2013): 269-277.

    Nippold, Marilyn A. 2010. “Back to School: Why the Speech-Language Pathologist Belongs in the Classroom.” Language, Speech, and Hearing Services in Schools 41 (4): 377–378.

    Vugs, B., Cuperus, J., Hendriks, M., & Verhoeven, L. (2013). Visuospatial working memory in specific language impairment: A meta-analysis. Research in Developmental Disabilities, 34(9), 2596-2597.

  • Why do so many students with language disorders also struggle with literacy?

    There is a significant overlap between language disorders and literacy difficulties. 50% of young people with Developmental Language Disorder (DLD) are unable to read simple texts, and more than 80% struggle to understand what they read (RCSLT et al, 2023). When a survey of children attending a special school for those with Specific Language Impairment (SLI) was taken, 75 out of 82 had reading difficulties (Haynes and Naidoo, 1991, cited in Bishop and Snowling, 2004).

    There is also evidence of oral language difficulties in those with dyslexia. In one study of 110 children diagnosed with specific reading difficulties, just over half scored more than one standard deviation below the mean on the CELF-R (Clinical Evaluation of Language Fundamentals – Revised: a language battery designed to identify language disorders) (McArthur et al, 2000, cited in Bishop and Snowling, 2004).

    In another landmark study, Scarborough and Dobrich (1990) monitored a small group of children diagnosed with “early language difficulties” over the years. Although their deficits grew milder over time and appeared to naturally resolve by the age of 5 or 6, when they were followed up again 3 years later, 3 out of 4 had severe reading difficulties.

    Bishop and colleagues observed a similar pattern with older students. 60 children with language disorders were identified at age 4, and reassessed at different times over the years. Strikingly, at ages 15-16, 52% of the resolved group, and 93% of the continuing poor outcome group scored below a twelve year old level on a reading test (Bishop & Adams, 1990; Bishop & Edmundson, 1987; Stothard, Snowling, Bishop, Chipchase, & Kaplan, 1998 cited in Dale et al, 2014).

    Bishop (2014) points out that since oral and written language difficulties have traditionally been dealt with by different professionals (Speech and Language Therapists (SLTs) and Educational Psychologists/ Specialist Dyslexia Tutors respectively), this overlap has not always been appreciated. However, as our understanding of these conditions has evolved, the sharp dividing line between them has been questioned.

    Some have gone so far as to argue that DLD and dyslexia are not two separate conditions, but one, presenting at different points on a continuum, or at different points of development. This has even led to some researchers adopting new terms, such as “language learning impairment”, or “language learning disorder” to encompass oral and/ or written language difficulties (Bishop and Snowling, 2004, Paul and Norbury, 2012).

    The reconceptualization of dyslexia has contributed to this converging. Historically known as “word blindness”, dyslexia was seen as a visual processing disorder where words would appear to “jump” out of the page, and students would mix letters up or reverse them. However, most cases of dyslexia are now considered to be linked to poor phonological awareness, which is the ability to recognize, segment, blend and manipulate sounds in words.

    Those who see DLD and dyslexia as part of a continuum point to the presence of similar phonological processing difficulties in some students with language disorders as well as other shared underlying difficulties. For example, some studies have highlighted difficulties with auditory perception (the brain’s ability to make sense of sounds), as well as poor performance on nonword repetition tasks (repeating made up words) in both groups (Bishop and Snowling, 2004).

    Given the degree of overlap between DLD and dyslexia, it seems likely that there are some shared etiologies. However, Bishop and Snowling (2004) argue that talking of the two as one is an oversimplification, and that it is useful to keep the categories separate. The signs of classic dyslexia look quite different to the main behaviours that characterize DLD.

    For one thing, a significant proportion of those identified with poor phonological awareness and decoding (word reading) ability do not have any major problems understanding text (Bishop and Snowling, 2004). In fact, there is some evidence that these “poor decoders” develop more advanced reading comprehension strategies and exploit their background knowledge to compensate for their difficulties (Catts et al, 2006, Snyder and Caccamise, 2010).

    This is in direct contrast to many students with DLD, and those known as “poor comprehenders” who often struggle to understand text despite being able to read it (although some students with DLD may be in the unlucky position of struggling with both decoding and understanding). (See my post: https://secondaryschoolslt.wordpress.com/2026/03/26/why-do-some-students-struggle-to-understand-what-they-read/ for more information.)

    For students like these, poor vocabulary and knowledge of advanced syntax may lead to difficulties with understanding, especially at secondary level, when the complexity of written language increases significantly. (See my post: https://secondaryschoolslt.wordpress.com/2026/04/15/what-is-expository-discourse-and-how-is-it-relevant-at-secondary-school/ for more information about this type of academic language.) As Paul and Norbury (2012, p.410) put it, “reading is a language-based skill, and understanding meaning through reading makes use of all the same processes used to extract meaning from oral language”.

    There may also be other reasons for the apparent overlap between the two disorders. Students with dyslexia who lack the ability or motivation to read age-appropriate texts will not be exposed to the same range of vocabulary and sentence structures as their peers, potentially causing them to fall behind with their language skills.

    Conversely, certain areas of language may be more connected to decoding and spelling than they appear at first glance. Students with language disorders with a weak grasp of grammatical morphology (the awareness of how words are made up of smaller, meaningful units, called “morphemes”, including prefixes, roots and suffixes), for example, may struggle to spell.

    To sum up, DLD frequently occurs alongside other neurodevelopmental disorders, including literacy difficulties. As SLTs, we’re likely to have many students on our caseloads who are struggling with their reading and writing for a variety of reasons. As specialists in language, we’re being increasingly expected to play a role in supporting our students with these difficulties, and are well placed to do so (Paul and Norbury, 2012). But first we need to understand the exact nature of our students’ difficulties if we are to help them.

    Notes

    Bishop, Dorothy V. M., and Margaret J. Snowling. 2004. “Developmental Dyslexia and Specific Language Impairment: Same or Different?” Psychological Bulletin 130 (6): 858–886. 

    Bishop, D.V.M. (2014). Ten questions about terminology for children with unexplained language problems. International Journal of Language & Communication Disorders, 49(4), pp. 381-415.

    Catts, Hugh W., Suzanne M. Adlof, and Susan Ellis Weismer. “Language Deficits in Poor Comprehenders: A Case for the Simple View of Reading.” Journal of Speech, Language, and Hearing Research 49, no. 2 (2006): 278–293.

    Dale, Philip S., Angela J. McMillan, M. E. Hayiou-Thomas, and Robert Plomin. “‘Illusory Recovery’: Are Recovered Children With Early Language Delay at Continuing Elevated Risk?” American Journal of Speech-Language Pathology 23, no. 3 (August 2014): 437–447.

    Paul, R. and Norbury, C. (2012) Language Disorders from Infancy Through Adolescence: Listening, Speaking, Reading, Writing, and Communicating. 4th edn. St. Louis, MO: Elsevier.

    Royal College of Speech and Language Therapists (RCSLT). “A Vision for Developmental Language Disorder (DLD) for the UK” London: RCSLT, 2023. https://www.rcslt.org/wp-content/uploads/2023/10/A-Vision-for-Developmental-Language-Disorder.pdf. 

    Scarborough, Hollis S., and Wanda Dobrich. “Development of Children with Early Language Delay.” Journal of Speech and Hearing Research 33, no. 1 (1990): 70–83.

    Snyder, Lynn, and Donna Caccamise. “Comprehension Processes for Expository Text: Building Meaning and Making Sense.” In Expository Discourse in Children, Adolescents, and Adults: Development and Disorders, edited by Marilyn A. Nippold and Cheryl M. Scott, 13–39. New York: Psychology Press, 2010.

  • What is literate language and how is it relevant at secondary school?

    By the time they start primary school, most children have a robust lexicon of words that they are able to employ for different purposes (Benson, 2009). However, as they progress through the years, they begin to learn more and more words, slowly acquiring a rich and varied vocabulary, capable of expressing great subtlety in meaning.

    This includes more abstract and technical terms, as well as low frequency, subject-specific “Tier 3” words. Many of these words will be multisyllabic and morphologically complex, containing a root word and at least one affix (a prefix or suffix) (Nippold, 2018). This stage of vocabulary acquisition is typically associated with literacy development and increased exposure to written materials which contain more of these “literate” forms.

    Written language differs from oral language in a number of ways, but chiefly in the amount of contextualization or abstraction (Benson, 2009). Whilst oral language is supported by non-linguistic information such as the speaker’s use of gesture and tone of voice, as well as the physical surroundings in which the interaction takes place, written language must stand alone (Rubin, 1987). (For more information about the differences between oral and written language, see my post: https://secondaryschoolslt.wordpress.com/2026/04/06/how-are-oral-and-written-language-different/)

    This results in a particular style of language that is denser, with a more specified lexicon and advanced syntactic structures (Benson, 2009) to convey complex thoughts and relationships between ideas. This style, used in the “literate activities of reading, writing, listening to lectures, talking about language and thought and mastering the school curriculum” has been termed “literate language”, or the “literate lexicon” (Nippold, 1998, p.21).

    Words included under this umbrella are a wide range of conjunctions, adverbs of likelihood and magnitude, factive and non-factive verbs, metacognitive and metalinguistic verbs, polysemous and double function words, as well as adverbial conjuncts and derived nominals and adjectives (Nippold, 1998).

    Whilst simple coordinating conjunctions such as “and”, “but” and “so” are relied on in casual conversation, written and instructional discourse, especially at secondary level, is characterized by a wider range of subordinating conjunctions, including “whereas”, “unless” and “provided that”, to express more complex relationships between ideas (Balthazar et al, 2010).

    Although words such as “possibly”, “somewhat” and “barely” may not seem complicated, adverbs of likelihood and magnitude such as these are also key components of literate language, since they enable precision of thought that goes beyond simple, concrete descriptions.

    Certain types of verbs also contribute to the abstract nature and linguistic specificity of written discourse. Factive and non-factive verbs, such as “know”, “realise”, “believe” and “imagine” reflect different mental states and distinguish between concepts of truth and uncertainty. Metalinguistic verbs such as “assert”, “imply” and “concede”, as well as metacognitive verbs such as “hypothesise”, “infer” and “doubt” are also crucial for academic reasoning and constructing arguments.

    On a related note, polysemous and double function words such as “cold” or “sweet” require advanced metalinguistic awareness to understand that the same word can have different meanings depending on the context. Whilst many words have a casual, everyday sense that even young children will know, academic texts frequently feature the more abstract sense which won’t be learnt until later on (Nippold, 1998).

    At secondary level, adverbial conjuncts such as “consequently”, “subsequently”, “conversely”, and “ultimately” are also used increasingly (Nippold, 2016) in essays and other high level expository texts as a way of “signposting” information for the reader. These words connect ideas across sentences, rather than within sentences as conjunctions do.

    Other examples of literate words include derived nominals and derived adjectives. Derived nominals are nouns formed by adding suffixes to verbs, e.g. “condensation” from condense, whilstderived adjectives come from nouns e.g. “categorical” from category. Words such as these are commonly found in subjects such as science, mathematics and English literature (Nippold, 2018).

    In one study, Nippold examined a range of textbooks for the aforementioned subjects to see how often these types of words occurred. Out of a total of 16,028 words, she found 254 derived nominals and 273 derived adjectives. Although this may not seem like a huge number, she argued that they occurred often enough that any student who struggled with them could easily misinterpret key parts of the text (Nippold, 2018).

    Literate language also extends beyond the lexicon to certain types of sentence structure. Written sentences tend to be longer and more densely packed with information, with subordinate clauses arranged in hierarchical rather than linear fashion to highlight importance of ideas (Balthazar et al, 2010).

    According to Marilyn Nippold, these two features develop in tandem, in what she called the “lexicon-syntax interface” (Nippold, 2014). For example, she highlighted how the use of meta-cognitive verbs drives the use of nominal clauses, e.g. “she assumed that he would arrive” (Nippold, 2014). Elaborated noun phrases are also commonly used in subjects such as science to introduce specialist vocabulary, e.g. “sedimentary rocks, layers of compacted sand and marine shells, are formed over millions of years” (Balthazar et al, 2010).

    To reiterate, most children gradually develop an awareness of literate language features through repeated exposure to and engagement with complex written and instructional materials. Whilst young children tend to learn new words orally through informal conversation, this shifts around the fourth year of primary school (Nippold, 1998), as they move from the “learning to read” to the “reading to learn” stage.

    Older school children learn new words in three main ways: through direct instruction of curriculum vocabulary in their lessons, as well as employing the metalinguistic strategies of contextual abstraction and morphological analysis to their own independent reading (Nippold, 2018). These strategies entail working out the meanings of new words encountered in text from the context and from their constituent parts, respectively.

    Learning new words in this way requires not only metalinguistic awareness and knowledge of a range of different root words and affixes, but also a substantial amount of time spent reading challenging texts on a regular basis (Nippold, 2018). Research has found that active, proficient and motivated readers who are interested in a wide range of topics develop much larger vocabularies than struggling readers. (Nippold, 1998).

    Unfortunately, students with language disorders often fall into the latter category; many struggle to read at a basic level, or to understand what they read (Nippold, 2018). What’s more, those who did not manage to establish a solid basis in oral language skills earlier on in their schooling will have enormous difficulty engaging with more challenging literate language (Benson, 2009).

    Students with language disorders also tend to be less strategic learners (Nippold, 2018), with poorer metacognitive and metalinguistic awareness. Whilst this makes them less likely to use the aforementioned strategies, metalinguistic awareness is also intertwined with literate language on a deeper level, since words are chosen carefully to reflect nuances in meaning (Benson, 2009).

    Difficulties with literate language may appear subtle compared to more obvious oral language deficits. However, familiarity with this style is vital for academic success (Benson, 2009), and any difficulties will affect students’ ability to understand explanations in lectures and textbooks, to write essays and reports, and engage in debates. Ignorance of certain types of words such as derived nominals and adjectives may also hinder success in STEM related subjects and access to those fields (Nippold, 2018).

    For more information about the purpose and distinctive features of academic language, or “expository discourse”, please see my next post: https://secondaryschoolslt.wordpress.com/2026/04/15/what-is-expository-discourse-and-how-is-it-relevant-at-secondary-school/

    Notes

    Balthazar, Catherine H., and Cheryl M. Scott. “The Grammar of Information: Challenges for Older Students with Language Impairments.” Topics in Language Disorders 30, no. 4 (2010): 313–327.

    Benson, Susan E. “Understanding Literate Language: Developmental and Clinical Issues.” Contemporary Issues in Communication Science and Disorders 36 (Fall 2009): 174–78.

    Nippold, M.A. (1998) Later language development: The school-age and adolescent years. 2nd ed. Austin, TX: Pro-Ed.

    Nippold, Marilyn. (2014). Language Intervention at the Middle School: Complex Talk Reflects Complex Thought. Language, Speech, and Hearing Services in Schools. 45. 153-156. 10.1044/2014_LSHSS-14-0027.

    Nippold, Marilyn A. “Back to School.” Language, Speech, and Hearing Services in Schools 47, no. 4 (2016): 269–71.

    Nippold, Marilyn A. “The Literate Lexicon in Adolescents: Monitoring the Use and Understanding of Morphologically Complex Words.” Perspectives of the ASHA Special Interest Groups 3, no. 1 (2018): 211–221.

    Rubin, Donald L. “Divergence and Convergence between Oral and Written Communication.” Topics in Language Disorders 7, no. 4 (1987): 1-18. 

  • What is expository discourse and how is it relevant at secondary school?

    Expository discourse, or “informational language”, as suggested by the name, is language used to explain, inform and describe (Ukrainetz, 2024). Also known as “the language of the curriculum”, it is the academic language used in class lectures and textbooks, and required in student presentations, essays and reports. It’s also used when explaining how to bake a cake, in a textbook explanation of photosynthesis, or in an essay describing the causes and consequences of a historical event.

    There are different varieties of exposition, such as description, enumeration, causation, and comparing and contrasting; each has its own particular organizational structure and distinguishing features. What connects these disparate activities is an intent to convey factual or technical information in an abstract, generalized way (Ukrainetz, 2024).

    Whilst conversation and narrative discourse tend to be more personal and social in nature, often referring to specific people and events, informational language tends to relate to more general concepts and processes. Although specific events or experiences may be mentioned, they are typically transcended to focus on “what generally happens”. This is reflected in the use of the present and infinitive tenses, compared to the narrative past tense (Ukrainetz, 2024).

    Whilst narrative discourse predominates at primary school, and continues to develop at secondary school, expository discourse comes to the fore. Although less familiar, it is central to teaching and learning at the secondary level, and students are expected to spend a large part of their day reading and listening to expository discourse (Scott, 2009).

    Worryingly, expository discourse is also one of the hardest genres to understand (Nippold, 2017). In one study, primary school children were found to have consistently poorer understanding of expository texts than narratives (Snyder and Caccamise, 2008). Correspondingly, Cheryl Scott (2009) notes that informational sentences written by adults tended to be longer and more complex than narrative sentences.

    In another landmark study, Marilyn Nippold and colleagues recruited 120 typically developing individuals from ages 7 to 49 in order to compare conversational and expository speech samples across different ages. The conversational samples were based on common subjects such as participants’ friends, families, school, or work. For the expository sample, they asked participants to explain the rules of their favourite game or sport (Nippold et al, 2005).

    The results revealed greater syntactic complexity for the expository samples compared to the conversational samples across all age groups. Nippold argued that the increased cognitive demands of the expository task had compelled the subjects to use more advanced sentence structures (Nippold et al, 2005). In a later article, she asserted that “complex thought encourages complex talk” (Nippold, 2014).

    So what exactly makes expository discourse more complex, and harder to understand? In a general sense, since its object is to convey new information, exposition is inherently more challenging (Nippold, 2017). More specifically, there are numerous lexical, grammatical and structural features that distinguish expository text and make it more challenging for the average person, let alone those with language disorders.

    Firstly, expository texts have a higher proportion of content words (nouns, adjectives and verbs) than narratives or conversational discourse (Balthazar et al, 2010). Compared to the small, familiar lexicon of casual conversation, exposition is distinguished by a richer, more varied vocabulary through which to convey its various concepts. Words tend to be more precise, abstract and technical, as well as multisyllabic and often morphologically complex. According to Beck’s three tier hierarchy, advanced Tier 2 words as well as low-frequency and specialized Tier 3 words are more commonly found (Beck et al, 2013; Ukrainetz, 2024).

    Informational sentences also tend to be longer and more complex, involving multiple subordinate clauses structured in a hierarchical rather than linear fashion so as to highlight the most important information (Balthazar et al, 2010). Specific grammatical features of exposition that may be particularly difficult to understand include nominalization and pre- and post-modification of the noun phrase (Ukrainetz, 2024).

    Nominalisation is the process of turning a verb into a noun, and is commonly used in both science and history, e.g. “evaporation” (from evaporate), “neutralization” (from neutralize) and “colonisation” (from colonise). It is useful for writers since it allows them to pack more information into a sentence, but harder for readers because it hides the agent and action, making sentences feel denser and more abstract.

    Pre- and post-modification refers to adding words before or after a noun to add detail, creating a noun phrase. Again, it is commonly used in science and can serve a useful function as a way of teaching new vocabulary (Balthazar et al, 2010), e.g. “Chlorophyll, a pigment that causes plants to be green, is vital for photosynthesis”, and “the microscopic capillaries connecting the smallest arteries to the smallest veins”.

    In the first sentence, the noun “chlorophyll” is modified by following it with the appositive, “a pigment that causes plants to be green”, creating a noun phrase with a definition embedded. In the second instance, the pre-modifier “microscopic” and the following participial phrase, “connecting the smallest arteries…” give clues to the meaning of the word “capillary” in terms of size and location.

    These structures provide a useful way of teaching new information without using too many words. However, a student with poor syntactic knowledge would struggle to decipher sentences such as these and might miss out on the explanations. (For a more detailed look at some of the linguistic features that distinguish expository discourse, please see my post on literate language.)

    As touched on briefly earlier, exposition encompasses a wide range of different subgenres, each with their own distinguishing features, and this too, makes it difficult to engage with. Whilst a student can rely on the familiar structure of a narrative, many different rules have to be learnt for exposition, and some varieties have almost no structure (Ukrainetz, 2024).

    Ultimately, understanding and expression of expository discourse is a complex task requiring a rich and varied vocabulary, advanced grammatical understanding, awareness of different organisational structures and topic knowledge as well as other cognitive skills such as adequate working memory. Unfortunately, students with language disorders tend to struggle in all of these areas.

    Notes

    Balthazar, Catherine H., and Cheryl M. Scott. “The Grammar of Information: Challenges for Older Students with Language Impairments.” Topics in Language Disorders 30, no. 4 (2010): 313–327.

    Nippold, Marilyn. (2014). Language Intervention at the Middle School: Complex Talk Reflects Complex Thought. Language, Speech, and Hearing Services in Schools. 45. 153-156. 10.1044/2014_LSHSS-14-0027.

    Nippold, Marilyn A. 2017. “Reading Comprehension Deficits in Adolescents: Addressing Underlying Language Abilities.” Language, Speech, and Hearing Services in Schools 48 (2): 125–131.

    Nippold, Marilyn A., Linda J. Hesketh, Jill K. Duthie, and Tracy C. Mansfield. “Conversational versus Expository Discourse: A Study of Syntactic Development in Children, Adolescents, and Adults.” Journal of Speech, Language, and Hearing Research 48, no. 5 (October 2005): 1048–64.

    Scott, Cheryl M. “A Case for the Sentence in Reading Comprehension.” Language, Speech, and Hearing Services in Schools 40, no. 2 (2009): 184-191.

    Snyder, Lynn, and Donna Caccamise. 2008. “Comprehension Processes for Expository Text: Building Meaning and Making Sense.” In New Directions in Communication Disorders Research: Integrative Approaches, edited by M. A. Nippold and C. M. Scott, 13–39. New York: Psychology Press.

    Ukrainetz, Teresa A. “Evidence-Based Expository Intervention: A Tutorial for Speech-Language Pathologists.” American Journal of Speech-Language Pathology 33, no. 2 (2024): 654–675.

  • How are oral and written language different?

    Written language is not just oral language “written down”, but is different in both style and function. Whilst oral language is typically less formal, with concrete, familiar words and simpler sentences, written language tends to be denser and more information-heavy, with specialist vocabulary and complex sentence structures (Benson, 2009).

    These differences can be traced back to the different functions of each type of language, and the contexts in which they occur. Whilst oral language is typically face to face, with communication partners who are known well to us, written language is more solitary, to an unknown readership. It follows that oral language tends to communicate more personal and social content, whereas written language tends to convey more logical and informational content. (Rubin, 1987).

    Writing may take place over an extended period of time, whereas oral language is typically more spontaneous. When you speak, the words disappear, but writing leaves a permanent visual trace, which “serves as an adjunct to short- and long-term memory” (Rubin, 1987, p.2), allowing the writer to reflect on and revise the ideas generated.

    Having briefly outlined the broad differences between the two modes, I will now detail the resulting differences in structure and style. Much of the content for this post was drawn from Rubin’s still highly relevant article, “Divergence and convergence between oral and written communication” (Rubin, 1987).

    Firstly, the face to face context of oral communication results in language that is less precise, with  a smaller, more familiar lexicon. Since speakers are typically in the same place at the same time, and may share a whole range of common experiences and associations, they may refer to objects in the surrounding environment, or discuss “in jokes” more obliquely. Prosody and other non-verbal communication also support the oral message, allowing speakers to be less specific (Rubin, 1987).

    The spontaneous nature of oral communication also influences its informal style, filled with hesitations, interjections, false starts and self-corrections. Since speakers must invent their subject matter in real time, language tends to be more fragmented and less cohesive with more tenuous connections. Sentences tend to be more basic as well as redundant, joined by simple connectives such as “and”, “but” or “so” (Rubin, 1987).

    This repetitive, more simplistic style of communication not only takes the pressure off the speaker, but also serves a role for the listener. Since they have no control over how fast or clearly their communication partner speaks, or any distracting environmental stimuli which may further affect the message, these integral elements of oral communication can help them to interpret the message the second time around. What’s more, immediate feedback allows any misunderstandings to be cleared up immediately (Rubin 1987).

    Writers, on the other hand, share no common physical or temporal context with their readers and cannot assume any prior understanding on their behalf. Unlike oral communication, writing is unsupported by any nonlinguistic clues and must stand alone. For the message to be understood, language must be precise, with referents clearly specified, using more advanced, technical terms and a greater range of vocabulary to clearly delineate meaning (Rubin, 1987).

    Since writing also allows time for reflection, it encourages greater creativity and higher level thought, which require more complex means of expression. This results in more elaborate language distinguished by longer clauses, advanced syntactic structures and a wider range of connectives as well as greater use of subordination as different propositions are organized in hierarchical fashion. Revision also allows writers to pack information more tightly and avoid repetition (Rubin, 1987).

    To support readers to understand this more complex, written language, writers need to ensure that their texts are cohesive, and appear as a unified whole. Writers also use organizational cues, such as transition statements, and orthographic markers such as punctuation and splitting ideas into paragraphs to support their readers to decipher their messages (Rubin, 1987).

    Rubin (1987) is quick to note that oral and written language are not completely distinct from one another, but overlap, and exist on a spectrum. At times, oral language may appear more “literate”, as in the prepared, formal speech of a barrister, whilst written language may contain more “orality”, as in a first person narrative, where we really “hear” the character’s voice (Rubin, 1987).

    He observes how the written language of novices is often not that far from their speech. But with repeated exposure to written text, students begin to develop an awareness of the differences between written and oral communication. Intent on exhibiting this distinction, some insecure writers may attempt to write in a hypercorrect way, in an unrealistic stereotype of what they think written language is. However, “for those who develop into expert, practiced writers… writing and speech reconverge” (Kroll, 1981 cited in Rubin, 1987, p13).

    As Speech and Language Therapists, knowing the differences between oral and written communication may help us in better understanding our students’ needs. Working in a secondary school context, I come across many who are competent oral communicators, but who struggle with the more technical vocabulary and advanced sentence structures characterized by the written form. These students will need our support to access the curriculum as they progress through school and are expected to engage with increasingly complex written materials.

    For more information about expository discourse, the heavily literate language of secondary school, please see my post: https://secondaryschoolslt.wordpress.com/2026/04/15/what-is-expository-discourse-and-how-is-it-relevant-at-secondary-school/

    Notes

    Benson, Susan E. “Understanding Literate Language: Developmental and Clinical Issues.” Contemporary Issues in Communication Science and Disorders 36 (Fall 2009): 174–78.

    Rubin, Donald L. “Divergence and Convergence between Oral and Written Communication.” Topics in Language Disorders 7, no. 4 (1987): 1-18. 

  • Why do some students struggle to understand what they read?

    Reading comprehension is not a single skill, but a complex task underpinned by a range of different abilities and knowledge (Catts, 2021). To understand a text, students must first have adequate sight reading and decoding abilities, as well as fluency in reading. They will need to have adequate background and vocabulary knowledge, and be able to use a range of metalinguistic strategies to work out the meanings of new words as well as to monitor and repair any gaps in understanding.

    They will also need adequate working memory to keep the relevant information in mind and piece it all together into a coherent whole. On top of all this, to truly engage with a text, students will need to infer, reason, compare and contrast, summarise information, problem solve and interpret. Given the complexity of the task, some have gone so far as to call it, “thinking guided by print” (Catts, 2009).

    Catts (2021) emphasized the particular importance of background knowledge in understanding a text. Whilst we may think of reading as a way of learning new information, research has shown that our prior knowledge of the general domain of the text greatly influences comprehension. In one study, poor decoders who were knowledgeable in the subject matter (baseball) outperformed good decoders with poor understanding of the subject (Catts, 2009).

    This may be because new information needs something to hook onto: an anchor (Catts, 2021). When we read a text, we are not so much learning new information, as we are integrating it with our own prior knowledge to create a dynamic “situational model” (Catts, 2009). Having an awareness of the topic can also prevent us from going off on the wrong track, and guide us in making inferences. It is likely that having some background knowledge will also allow students to think more deeply about the topic, due to freeing up working memory space (Catts, 2021).

    Another important aspect of reading comprehension which has sometimes been overlooked, yet is especially relevant to Speech and Language Therapists (SLTs), is sentence comprehension. In her article, “A Case for the Sentence in Reading Comprehension”, Cheryl Scott (2009) argues that many reading comprehension problems are actually the result of undetected sentence processing difficulties. There is a fair amount of evidence for her position.

    Traditionally, students with “literacy difficulties” have been split into two camps: “poor decoders” and “poor comprehenders”. Poor decoders are those who struggle to translate letters into sounds, to blend them together to make words, to read fluently: those who could also be described as “dyslexic”. Poor comprehenders, on the other hand, have no problem with the reading process itself, but they struggle to understand the meaning of a text. Approximately 5-10% of school children could be said to fit into this category (Catts et al, 2006).

    A range of studies have found evidence of weak underlying language abilities in this group. For example, Catts’s group of poor comprehenders scored near the 20% percentile for receptive vocabulary, and near the 30th percentile for grammatical understanding. He observes that although mild, and “subclinical”, these difficulties may be enough to have a significant impact on complex reading comprehension tasks. Whilst these difficulties were often present from kindergarten, only a small percentage of these children had met the criteria for a language disorder, with very few receiving support from an SLT (Catts et al, 2006).

    Despite these findings, reading comprehension interventions have traditionally prioritized the teaching of generic strategies over targeting any underlying language deficits. But Cheryl Scott (2009) observes that if a student is unable to parse individual sentences to derive meaning from them, then they will struggle to understand at text level. Marylin Nippold (2017) also questions how we can expect students to grasp the main idea, or to summarise a passage if they have not understood the individual sentences it is composed of.  Although reading comprehension strategies may be useful to some students, they are unlikely to be effective unless underlying language deficits are addressed first.

    Given the myriad skills required by the task of reading comprehension, it is no wonder that students with underlying language difficulties struggle so much. Besides having poorer vocabularies and syntactic ability as mentioned previously, some of these students may have associated difficulties with working memory and literacy. They are also likely to have poorer background knowledge by dint of their reading difficulties and possible reluctance with reading. Thus, a vicious cycle is born, where students see their difficulties compounded.

    As SLTs, it may be worth paying particular attention to the overlooked role of syntax (Nippold, 2017): something we are very specifically qualified to address. This is particularly relevant to the secondary school years, as students are expected to understand increasingly complex sentence structures (see my post). Indeed, it is no coincidence that a group of “poor comprehenders” typically emerge at this time (Scott, 2009). Unfortunately, there is still a great need for research in this area (Nippold, 2017).

    Notes

    Catts, Hugh W., Suzanne M. Adlof, and Susan Ellis Weismer. “Language Deficits in Poor Comprehenders: A Case for the Simple View of Reading.” Journal of Speech, Language, and Hearing Research 49, no. 2 (2006): 278–293.

    Catts, Hugh W. “The Narrow View of Reading Promotes a Broad View of Comprehension.” Language, Speech, and Hearing Services in Schools 40, no. 2 (April 2009): 178–183. 

    Catts, Hugh W. “Rethinking How to Promote Reading Comprehension.” American Educator 45, no. 4 (Winter 2021-2022): 26–33. 

    Nippold, Marilyn A. 2017. “Reading Comprehension Deficits in Adolescents: Addressing Underlying Language Abilities.” Language, Speech, and Hearing Services in Schools 48 (2): 125–131.

    Scott, Cheryl M. “A Case for the Sentence in Reading Comprehension.” Language, Speech, and Hearing Services in Schools 40, no. 2 (2009): 184-191.

  • What are the main challenges of secondary school for students with language disorders?

    The move to secondary school (age 11 in the UK) is difficult for any Year 7 student, but especially so for those with language disorders. On a basic level, secondary schools are typically much bigger than primary schools. The number of students to a class can double in size, and there are large, confusing buildings to navigate.

    At primary school, most pupils have one main classroom teacher who is with them for all their subjects, with whom they can form a more intimate relationship. But at secondary school, students usually have a whole range of teachers for different subjects. Timetables become more challenging to follow, as students have to find their way to different classrooms. Since teachers have so many students, they may struggle to get to know them on an individual basis, and any learning difficulties are more likely to go unnoticed. In short, it is easier to get lost in secondary school.

    Expectations also increase dramatically. Students have to contend with a wide range of subjects involving advanced concepts and specialist vocabulary. They are required to complete higher level tasks, such as analysing literature, writing extended essays and reports, preparing presentations, undertaking research, engaging in critical thinking and debate, and preparing for and sitting exams.

    Workloads increase. To succeed, students must learn to work independently and to manage their time effectively, as well as follow the (often unspoken) rules and routines of school (Nelson, 1998). All of this can feel like something of a shock following the friendly, informal context of primary school.

    On top of all this, these young students must learn to navigate a new social landscape and to find their place in the world, away from the family unit. At a time when their bodies are beginning to change and social interactions are becoming more complex, preadolescents and adolescents must attempt to forge new friendships, find their “group”, avoid being the subject of bullying and attempt to establish a personal identify (Larson and McKinley, 2003).

    Secondary school also brings with it a couple of important, unique challenges which are worth expanding on further, since they particularly affect those with language disorders. The first is a shift which begins in Years 3 and 4, but becomes more pronounced in secondary school, from “learning to read” to “reading to learn” (Balthazar and Scott, 2010).

    One of the main goals of the primary school years is the acquisition of literacy, achieved through regular phonics classes, individual reading and whole class storytelling sessions. At secondary school, it is assumed that most students are able to read and write fluently, so the same level of support is not offered to those who continue to struggle. (Although, positively, some of the better equipped schools I have worked for have offered an online literacy program called “Lexia”).

    Not only will students still struggling with literacy find themselves unsupported, but in the “reading to learn” stage they are now expected to learn new information through their reading. They must move beyond a basic understanding of the text, to draw inferences, analyse, compare and contrast, synthesise and summarise information and think critically (Balthazar and Scott, 2010).

    Clearly any student who has not yet mastered basic decoding skills or reading fluency, who may not even fully understand what they’re reading, will struggle enormously with these higher level tasks. Unfortunately, given the considerable crossover between language and literacy difficulties (see my post for more information), many students with language disorders will fall into this category. Since most subject teachers are unable to dedicate time within the busy classroom to support these students, many will struggle to access the curriculum.

    What’s more, whilst young children typically learn new words through oral exposure, most secondary school students are learning more and more words through their independent reading (Nippold, 1998). Those who avoid reading or who read texts below their cognitive capacity due to residual reading difficulties will have reduced exposure to new vocabulary and linguistic structures. This in turn can negatively impact their language development, leading to the “Matthew effect”, where the rich get richer and the poor get poorer (Snyder and Caccamise, 2008)

    So far, I’ve hinted at the increasing complexity of the language used and demanded at secondary school but have not fully discussed its nature and causes. Firstly, the shift from oral to written communication is more fundamental than a change in medium. Written language is not just oral language “written down”, but is different in both style and function (Rubin, 1987, Nippold, 1998). (For more information about the differences between oral and written language, please see my post: https://secondaryschoolslt.wordpress.com/2026/04/06/how-are-oral-and-written-language-different/)

    Broadly speaking, oral language tends to be less formal, with more familiar vocabulary and simpler sentence structures (Benson, 2009). Written language by contrast tends to be more formal, precise, and information-dense, characterized by a wide range of vocabulary that is richer, more technical and specific in nature, as well as more complex use of syntax (Rubin, 1987, Benson, 2009). Marilyn Nippold also termed this style of language and vocabulary, “literate language”, or the “literate lexicon” (Nippold, 1998). (See post for more details).

    Closely connected with these points, is the emergence of a new type of discourse at secondary school. Whilst narratives predominate in primary school, and continue to develop at secondary, other types of discourse come to the fore: most notably, “expository discourse”, or “expository text”.

    Expository discourse is the language of the classroom, of lectures, textbooks and essays. It is language used to explain, define, inform or instruct. Since its main purpose is to convey new information, it is inherently difficult to understand (Snyder and Caccamise, 2008). And once again, those with language disorders will find it particularly challenging since it tends to be dense, information heavy, with complex vocabulary and syntax (Paul and Norbury, 2012) (See my post: https://secondaryschoolslt.wordpress.com/2026/04/15/what-is-expository-discourse-and-how-is-it-relevant-at-secondary-school/ for more information).

    Despite the move to secondary school being such a challenging time, it has traditionally been when many students with language disorders have been discharged from caseloads (Larson & McKinley 2003). Plenty of recent evidence also indicates that support falls away quickly after primary school (RCSLT, 2023). Given what is at stake, some experts in the field recommend at least supporting students through this difficult transition (Larson & McKinley, 2003).

    You could say that this stage of development also brings with it unique opportunities. There is some evidence that subsequent periods of brain growth occur during the adolescent years, bringing opportunities for growth that may not have been possible earlier on (Larson and McKinley, 2003). What’s more, the increasing cognitive and linguistic demands of the secondary setting can drive further development (Nippold, 1998, 2014) when students are supported effectively. In other words, secondary school is not too late; it may be the perfect time to intervene.

    Notes

    Balthazar, Catherine H., and Cheryl M. Scott. “The Grammar of Information: Challenges for Older Students with Language Impairments.” Topics in Language Disorders 30, no. 4 (2010): 313–327.

    Benson, Susan E. “Understanding Literate Language: Developmental and Clinical Issues.” Contemporary Issues in Communication Science and Disorders 36 (Fall 2009): 174–78. doi.org.

    Larson, V.L. and McKinley, N.L. (2003) Communication solutions for older students. Thinking Pub. 

    Nelson, N. W. (1998) Childhood Language Disorders in Context: Infancy Through Adolescence. 2nd edn. Boston, MA: Allyn & Bacon.

    Nippold, M.A. (1998) Later language development: The school-age and adolescent years. 2nd ed. Austin, TX: Pro-Ed.

    Nippold, Marilyn. (2014). Language Intervention at the Middle School: Complex Talk Reflects Complex Thought. Language, Speech, and Hearing Services in Schools. 45. 153-156. 10.1044/2014_LSHSS-14-0027.

    Paul, R. and Norbury, C. (2012) Language Disorders from Infancy Through Adolescence: Listening, Speaking, Reading, Writing, and Communicating. 4th edn. St. Louis, MO: Elsevier.

    Royal College of Speech and Language Therapists (RCSLT). “A Vision for Developmental Language Disorder (DLD) for the UK” London: RCSLT, 2023. https://www.rcslt.org/wp-content/uploads/2023/10/A-Vision-for-Developmental-Language-Disorder.pdf. 

    Rubin, Donald L. 1987. “Divergence and Convergence between Oral and Written Communication.” Topics in Language Disorders 7 (4): 1–18.

    Snyder, Lynn, and Donna Caccamise. 2008. “Comprehension Processes for Expository Text: Building Meaning and Making Sense.” In New Directions in Communication Disorders Research: Integrative Approaches, edited by M. A. Nippold and C. M. Scott, 13–39. New York: Psychology Press.

  • What is cognitive referencing and should Speech and Language Therapists (SLTs) use it?

    Cognitive referencing, also known as the discrepancy model, refers to the outdated practice of determining eligibility for a diagnosis, and/or Speech and Language Therapy (SALT) services by comparing an individual’s language abilities with their non-verbal IQ. According to this, children with language difficulties would be expected to have average overall intelligence, i.e. there ought to be a large “discrepancy” between their verbal and nonverbal scores in order to qualify for SALT support.

    The reason for this was that a certain level of cognition was believed necessary to make progress with language skills, and therefore to benefit from intervention. An individual’s nonverbal intelligence scores were considered the “ceiling” up to which progress could be made. In areas where services were very stretched, and where it was felt necessary to prioritise those who would benefit the most, below average IQ was sometimes used as a reason to deny services.

    This practice was quite common during the 1980s and 1990s, especially in school settings, and it is still used in some circles now. The previously used label of Specific Language Impairment (SLI), also used cognitive referencing as part of its “exclusionary criteria”. Since it was meant to identify language disorders that were “specific” in nature, i.e. occurring in the absence of any other difficulties, such as hearing impairment or general cognitive deficits, those with low non-verbal IQ were automatically excluded.

    However, the very notion of a “pure” language disorder is questionable, and the exception rather than the rule in clinical practice anyway. If we were to restrict support to only those who presented with “pure” language disorders, then we risk denying services to those most in need (Bishop et al, 2016). In 2016, a panel of experts rejected the label as “not reflecting clinical realities” (Bishop et al, 2016) and it has now been replaced with the more inclusive “Developmental Language Disorder” (DLD), which does not apply such restrictions.

    For further discussion on terminology, please see my article: https://secondaryschoolslt.wordpress.com/2026/02/26/developmental-language-disorder-a-brief-history-of-terminology/

    There are several other problems with cognitive referencing, and many experts in the field, e.g. Larson and McKinley (2003) have argued strongly against the practice over the years. For one thing, the supposedly nonverbal tests used are rarely a pure measure of nonverbal ability (Paul & Norbury, 2012). While the test items themselves use visual stimuli, some type of oral instructions are usually involved.

    What’s more, children who employ verbal strategies such as inner speech may have an advantage over their peers when solving the complex problems involved in these tests. Since those with language disorders do not tend to use these kind of strategies they are likely to score lower. Ironically, the very tests used to help identify those in need of support are likely to disadvantage those most in need.

    Secondly, whereas cognition was previously understood to underlie and to support language skills, the relationship between the two is now considered to be more complex and bi-directional. For a start, individuals with poor non-verbal ability, yet strong language ability do exist (Larson and McKinley, 2003). This finding alone appears to disprove the theory that a certain level of cognition is needed to make progress with language skills. And individuals with poor nonverbal IQ have been found to benefit from intervention too (Paul & Norbury, 2012, p. 7).

    Speaking of the interplay between verbal and nonverbal abilities, Marilyn Nippold (2014) observed in one paper how “complex talk reflects complex thought”. During one study, she found that challenging students to complete more demanding tasks or use more advanced forms of discourse pushed them to use longer, more complex sentence structures than they would otherwise. I imagine that both influence each other in a symbiotic way: if students’ understanding of a particular concept or topic is vague, and they lack the means to express themselves on it, then providing them with the words and sentence structures to do so may help to elucidate it for them.

    I have personally experienced how writing, the process of putting different words together, and rearranging sentences can help to develop and refine my thinking. Thought without words or images is likely possible, but I imagine it to be a hazy, undefined sort of thing; words can give form and solidity to those ideas forming in the background.

    As an optimist, I see in this an opportunity to support our students beyond what might be considered the boundaries of SLT; if we can give our students words and structures to help them think, then why wouldn’t we? Ultimately, I agree with Larson and McKinley (2003), who stress that we should be thinking of reasons to provide services to adolescents, rather than withhold them.

    Notes

    Bishop DVM, Snowling MJ, Thompson PA, Greenhalgh T, CATALISE consortium (2016)

    CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language

    Impairments in Children. PLoS ONE 11(7): e0158753. doi:10.1371/journal.pone.0158753

    Bishop, D.V.M., Snowling, M.J., Thompson, P.A., Greenhalgh, T., and 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, 58(10), pp. ​ 1068–1080. doi:10.1111/jcpp.12721​

    Larson, V.L. and McKinley, N.L. (2003) Communication solutions for older students. Thinking Pub. 

    Nippold, Marilyn. (2014). Language Intervention at the Middle School: Complex Talk Reflects Complex Thought. Language, Speech, and Hearing Services in Schools. 45. 153-156. 10.1044/2014_LSHSS-14-0027.

    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, 57(11), pp. 1247–1257. Available at: https://acamh.onlinelibrary.wiley.com/doi/10.1111/jcpp.12573

  • What does “illusory recovery” mean?

    The term was originally coined by Scarborough and Dobrich (1990) in their renowned article, “Development of children with early language delay” (Scarborough and Dobrich, 1990). The authors were trying to reconcile two slightly contradictory findings in the literature: that “late talkers” (“children with limited expressive vocabulary at 18-24 months” (Bishop et al, 2016)) often recover by age 5 or 6, and simultaneously, longer term studies showing that many experience residual language and literacy difficulties in later childhood and beyond.

    Scarborough and Dobrich wondered whether apparent recovery followed by longer term difficulties might occur within the same child. As part of their research, they compared four children with “early language delay” and a control group of twelve children at ages two and a half and five, and then followed them up three years later. The language abilities of the first group seemed to naturally improve over time, and at age five they were judged to be “near normal”. However, when they were followed up in Year 2, three of the four had severe reading difficulties.

    Scarborough and Dobrich (1990) thought that this could be explained by their theory of “illusory recovery”. They observed that the language of the typically developing children did not develop evenly, but in a stepwise manner, with a series of growth spurts and plateaus. They proposed that as most children reach a plateau, the “delayed” children may seem to “catch up” temporarily, only for their underlying difficulties to show up again at the next developmental stage.

    The authors acknowledged that it would be difficult to generalize from their small sample, and some have contested their results. In a large scale study, Dale et al (2014) found that children with “early language delay” were at no greater risk of long-term difficulties than those without a past history, but with similar scores at age 4. There is now a consensus that early language skills are highly variable and outcomes are difficult to predict (Bishop et al, 2016).

    Regardless, some children clearly do appear to catch up temporarily, only for their difficulties to re-surface later. As a secondary school Speech and Language Therapist (SLT), this got me thinking about my own students. Those who I see tend to fall into one of three camps: those with recognized difficulties, who have received statutory support throughout their schooling, those who saw an SLT when they were younger, only to be discharged as their difficulties “resolved”, and a final group who had never even been flagged up before.

    I’m continually surprised by the numbers who show up in my office with severe language disorders, some having been discharged a few years earlier, and many having never been seen before. Can it be that so many struggling students were missed at primary school? Does Scarborough and Dobrich’s logic apply to some of these students? Or could there be other reasons why difficulties may seem to re-emerge at this point, or even emerge for the first time?

    Scarborough and Dobrich were not the first to propose that language develops in a stepwise fashion. In Walter Loban’s (1976) groundbreaking longitudinal study, he followed 211 pupils from kindergarten into early adulthood and documented their progress. He observed a similar pattern beyond early childhood and into secondary school, although the exact stages depended on the measures he used.

    For example, in terms of the average number of words used per communication unit, he noted that for his “random” group, a year of growth was almost always followed by a year of plateau, or what he also called a “consolidation phase”. There were even crossover points on some of his graphs, which seemed to show his low group catching up with his high group. Again, this was only true for certain measures, such as the number of dependent clauses used per sentence.

    However, when Loban studied them further, he found that his high ability group’s writing samples were actually of much higher quality, despite the data looking similar. The ability to create multiclausal sentences may well be a sign of linguistic growth, but as children mature further still, they actually learn to be more concise, replacing cumbersome clauses with less frequent syntactic structures such as appositives, and infinitival phrases.

    What Loban’s graph showed, then, was not the low group catching up as the high group reached a plateau, but rather, the high group reaching the next developmental stage which was characterized by different markers. How we read the data, and how we measure growth, then, is important.

    Researchers in the field have cautioned how some assessment tools for older students only assess relatively basic skills. A student with more subtle difficulties is likely to be missed. Whilst these factors may contribute to some cases of “illusory recovery”, there are likely to be additional elements involved.

    In Cheryl Scott’s article, “A Case for the Sentence in Reading Comprehension” (Scott, 2009), she argued that many reading comprehension difficulties are linked to sentences increasing in length and complexity throughout school. As students reach secondary school, they are expected to understand much harder written texts, with language beyond what they would encounter in casual conversation. It is no coincidence that many “poor comprehenders” emerge at this point.

    (See my post for further information about the challenges of academic text, or “expository discourse”: https://secondaryschoolslt.wordpress.com/2026/04/15/what-is-expository-discourse-and-how-is-it-relevant-at-secondary-school/ .)

    It may be, then, that some deficits are mild enough to go unnoticed throughout early childhood and the more informal context of primary school, only to become painfully apparent in the more serious environment of secondary school where expectations are much higher. Larson and McKinley (2003), too, observed that difficulties are likely to re-emerge as the linguistic and cognitive demands of a new context increase, such as in the transition to secondary school.

    (For more information about the challenges of secondary school, please see my post: https://secondaryschoolslt.wordpress.com/2026/03/18/what-are-the-main-challenges-of-secondary-school-for-students-with-language-disorders/. )

    Another confounding factor, is that whilst language disorders are chronic, they are not stable. So, an early difficulty with oral language may evolve into more of pragmatic difficulty, or a difficulty with reading and writing later on, as in the Scarborough and Dobrich study (1976). Someone with a surface level understanding may consider the initial language disorder resolved, only to be replaced by a separate reading difficulty.

    It is more likely that these are different manifestations of the same, underlying condition. Some areas, such as vocabulary or basic syntax may improve due to internal shifts, or external factors such as successful intervention (hopefully!), only for other challenges to come to the fore for the reasons already discussed.

    I hope to have shown how relevant the concept of “illusory recovery” is to older students. In my experience, many students arrive at secondary school with language disorders which were deemed to have “resolved”, or were never even picked up before. They may have seemed to have gotten better in the past due to successful intervention efforts, the naturally evolving nature of their condition, or possibly the use of inappropriate or insensitive assessment tools. Their underlying difficulties then appear to re-emerge with the increasing demands or secondary school, or possibly as other students move on from a developmental plateau, leaving them behind.

    For more information on whether language disorders persist, please see my article:

    Do language disorders go away?

    Notes

    Bishop DVM, Snowling MJ, Thompson PA, Greenhalgh T, CATALISE consortium (2016). CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children. PLoS ONE 11(7): e0158753.

    Bishop, D.V.M., Snowling, M.J., Thompson, P.A., Greenhalgh, T., and 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, 58(10), pp. ​ 1068–1080.

    Dale, Philip S., Andrew J. McMillan, Marianna E. Hayiou-Thomas, and Robert Plomin. “‘Illusory Recovery’: Are Recovered Children with Early Language Delay at Continuing Elevated Risk?” American Journal of Speech-Language Pathology 23, no. 3 (August 2014): 337–46.

    Larson, V.L. and McKinley, N.L. (2003) Communication solutions for older students. Thinking Pub. 

    Loban, W. (1976) Language Development: Kindergarten through Grade Twelve. Urbana, IL: National Council of Teachers of English.

    Scarborough, Hollis S., and Wanda Dobrich. “Development of Children with Early Language Delay.” Journal of Speech and Hearing Research 33, no. 1 (1990): 70–83.

    Scott, Cheryl M. “A Case for the Sentence in Reading Comprehension.” Language, Speech, and Hearing Services in Schools 40, no. 2 (April 2009): 184–91.

  • Language Disorders: Is there a difference between disadvantage and disorder?

    There has been some debate over the years around whether a language disorder should be distinguished from language disadvantage. The link between low socio-economic status (SES) and language difficulties is well established. In some deprived areas, as many as 50% of children do not have appropriate language skills for their age (Roy & Chiatt, 2013). This far exceeds the generally quoted prevalence rate of 7% across the population.

    How can this be? The environments we grow up in strongly influence our own development, and it seems reasonable that poor linguistic input from parents could lead to language difficulties in their children. Indeed, one study found that pre-schoolers’ language patterns closely mirrored that of their parents, from the range of vocabulary they used, to their interaction styles (Roy and Chiatt, 2013).

    This has led some to ask: if these children’s difficulties are down to their environments, rather than some innate difficulty with language learning, is it still appropriate to diagnose a language disorder? Could some of these children have the potential for normal language development, but have lacked the opportunity or language experience? And finally, are language difficulties caused by these kind of external factors different from those caused by internal ones?

    Surprisingly, some patterns of difference have been observed. Some studies revealed that certain areas of language, such as vocabulary and multi-clausal sentences were more affected by SES than other areas, such as basic syntax (Roy and Chiatt, 2013). Other measures, such as non-word and sentence repetition, and use of grammatical inflections also appear to be less influenced by upbringing and are sometimes considered to be more reliable predictors of language disorder.

    Some researchers have accounted for these differences by theorizing that certain aspects of language development may be more “in-built” than others. Basic syntax, and the non-word repetition tasks mentioned earlier may rely more on innate language processing abilities, and where there is no internal deficit, these skills may develop normally. On the other hand, building a rich vocabulary is a more knowledge-based endeavor, which relies on repeated exposure to a wide range of words in the environment.

    Whatever the truth, in practice it is hard to differentiate between language difficulties caused by internal versus external factors, since risk factors tend to co-occur and interact. Social deprivation may lead to poorer language outcomes through the quality of language and interactions that children are exposed to in their environments. Or it may be due to heritable aspects which have been overlooked.

    In 2016, a group of international experts concluded that there was no particular language profile associated with social disadvantage, and that the aforementioned trends are not an adequate basis on which to classify children (Bishop et al, 2017).

    For more information on the causes of language disorders, please see my post:

    https://secondaryschoolslt.wordpress.com/2026/01/05/what-causes-language-disorders/

    Notes

    Bishop DVM, Snowling MJ, Thompson PA, Greenhalgh T, CATALISE consortium (2016)

    CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children. PLoS ONE 11(7): e0158753.

    Bishop, D.V.M., Snowling, M.J., Thompson, P.A., Greenhalgh, T., and 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, 58(10), pp. ​ 1068–1080. doi:10.1111/jcpp.12721​

    Roy, P. and Chiat, S. (2013). Teasing apart disadvantage from disorder The case of poor language. In: Marshall, C. R. (Ed.), Current Issues in Developmental Disorders. Current Issues in Developmental Psychology. (pp. 125-150). PSYCHOLOGY PRESS. ISBN 9781848720848

  • Are there different subtypes of language disorder?

    Developmental Language Disorder (DLD) is a broad category that encompasses a wide range of problems (Bishop et al, 2017). Some students may struggle to formulate complex, or even simple sentences; they may miss off grammatical inflections indicating verb tense or number, or experience other grammatical difficulties. For others, a small vocabulary, alongside difficulties learning new words and understanding the connections between words seems to be the main issue.

    Other students may have trouble following instructions, or remembering and understanding large amounts of spoken information, even though they know the individual words contained within it. Some may have good understanding and sentence formulation skills but have specific difficulties in the area of pragmatics.

    I have one student, for example, with weak inference skills, who struggles to make himself understood, even though his oral sentences are basically okay. When he speaks, his thoughts come out in a jumble, and he fails to consider what his conversation partner is likely to know already, either giving too little, or too much information.

    Do all of these students have the same problem? Or is the nature, and cause of their difficulties diverse? There have been attempts over the years to identify different subgroups within the broader category of DLD. You may have used the terms “receptive language disorder” or “expressive language disorder” yourself. The term “Pragmatic Language Impairment” has also been used to describe children with social and pragmatic difficulties who do not meet the criteria for Autistic Spectrum Disorder (ASD).

    However, when a group of international experts met in 2016 to attempt to reach a consensus on a range of issues, they were unable to agree on different subgroup classifications. They observed that the categories of receptive and expressive language disorder were rather “gross” and that subcategories were not stable over time (Bishop et al, 2017).

    In some longitudinal studies, researchers attempting to classify children into different subgroups found that those children moved fluidly between those groups over time (Paul & Norbury, 2012). So a child who was originally placed into a vocabulary group or a receptive language group might have ended up in a group for children with expressive language difficulties by the end of the study. This brings into question the integrity of these subcategory classifications, and the utility of imposing them on the broader category of DLD, at least given our current understanding.

    What these results do seem to suggest, is that whilst language disorders are chronic, the way that they manifest appears to change over time. This is likely due to a mixture of internal shifts as well as external factors such as successful intervention, combined with the increasing demands of new contexts, which may reveal difficulties across other areas.

    So, a child initially identified with oral language difficulties may gradually overcome those, only for difficulties with more complex written language to emerge as they grow older. Instead of treating these as two separate difficulties, it seems more likely that they are different manifestations of the same underlying problem.

    Finally, just as language disorders do not divide neatly into different subtypes, the boundaries between different neurodevelopmental disorders such as DLD, dyslexia and ASD may be less clear-cut than is commonly assumed. Until we fully understand the underlying mechanisms beneath these conditions, we are limited to what we see on the surface.

    For more information on whether there is a difference between language disadvantage and language disorder, please see my next post: https://secondaryschoolslt.wordpress.com/2026/03/06/language-disorders-is-there-a-difference-between-disadvantage-and-disorder/

    Notes

    Bishop DVM, Snowling MJ, Thompson PA, Greenhalgh T, CATALISE consortium (2016) CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children. PLoS ONE 11(7): e0158753.

    Bishop, D.V.M., Snowling, M.J., Thompson, P.A., Greenhalgh, T., and 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, 58(10), pp. ​ 1068–1080.

    Paul, R. and Norbury, C. (2012) Language Disorders from Infancy Through Adolescence: Listening, Speaking, Reading, Writing, and Communicating. 4th edn. St. Louis, MO: Elsevier.

  • Developmental Language Disorder (DLD): A brief history of terminology

    There has been a myriad of terminology used within the field of Speech and Language Therapy (SALT), and until recently, there was no agreed upon label for unexplained language difficulties (Bishop, 2014). Dorothy Bishop found that between 1994 and 2013, 132 different terms were used in the literature, with Specific Language Impairment (SLI) being the most common. By contrast, the term “dyslexia” was used in 93% of research papers to describe reading and writing disorders, rising even higher, to 99% later on (Bishop, 2014).

    She points out that this lack of consensus creates confusion and contributes to poor public awareness, as well as impeding research and even access to clinical services. Having multiple possible search terms for a particular condition makes it difficult to synthesise research, whilst the different diagnostic criteria associated with a range of labels risk inadvertently excluding deserving individuals from services.

    Of course, such inconsistency not only to causes confusion, but also probably reflects the existing confusion in the field. The words that we choose for certain concepts reveal how we think about those concepts. And this changing terminology mirrors our evolving understanding of the nature of these conditions, and what we consider to be the most salient aspects at a given moment.

    Older terms such as “developmental dysphasia”, for example, likely reflected the thinking of the time, which drew parallels between aphasia, the acquired condition suffered by adult stroke survivors, and the developmental difficulties observed in young children. The term “language delay”, which has sometimes been applied to young children hints at the possibility of them “catching up”, but was recently rejected by a panel of experts as “confusing and illogical” (Bishop et al, 2017).

    As mentioned earlier, the term “Specific Language Impairment”, or SLI, was until recently applied quite widely to language disorders which were deemed “specific” in nature, i.e. unrelated to another biomedical condition or to overall intelligence. In fact, getting an SLI diagnosis required a “discrepancy” between a child’s language abilities, and their non-verbal IQ scores. (See my post on “cognitive referencing” for more information: https://secondaryschoolslt.wordpress.com/2026/03/13/what-is-cognitive-referencing-and-should-speech-and-language-therapists-slts-use-it/)

    Inherent in this label was an assumption that language difficulties occurring in isolation are somehow intrinsically different from those forming part of a more general pattern of delayed development. This is far from clear, and in any case, “pure language difficulties” appear to be the exception, rather the rule in clinical practice (Bishop et al, 2016/7). The term has now been rejected as “not reflecting clinical realities”, whilst the word “specific” was considered misleading. Such a narrow definition has also likely led to many being denied services that they sorely needed.

    Given this confusing state of affairs, a panel of experts from a range of English-speaking countries met in 2016 and 2017 to resolve some of these disagreements and arrive at a consensus regarding terminology and diagnostic criteria. They agreed on three separate terms relating to language difficulties.

    “Language disorder” was proposed as an umbrella term for language difficulties likely to persist into middle childhood and beyond, significantly impacting on everyday interactions and educational progress, and unlikely to resolve without specialist support (Bishop et al, 2017). A child who is a second language learner and is struggling to learn the local language due to lack of experience would not be considered language disordered, unless they were also struggling in their mother tongue. The word “disorder” was chosen over “impairment” to emphasise the serious nature of the condition.

    The term “language disorder associated with X” applies to language disorders with a “differentiating condition”. According to the panel, this would be a biomedical condition with a genetic or neurological cause, where language difficulties occur as part of a more complex pattern of impairment, for example, traumatic brain injury, Down’s Syndrome, ASD or intellectual disability. They reasoned that different intervention pathways would be needed for such individuals in order to take into account the other features of their conditions (Bishop et al, 2017).

    Finally, the term “Developmental Language Disorder” applies to language disorders with no known differentiating conditions, yet to be explained. The word  “developmental” was chosen to emphasise that these difficulties occur during the course of development, rather than being acquired. The panel also stressed that in contrast to previous SLI diagnoses, a large discrepancy between verbal and nonverbal scores would not be required. So, hypothetically, a child with low nonverbal scores who did not meet the threshold for Intellectual Disability could still qualify for a diagnosis of DLD.

    As SLTs, this newfound agreement and clarity is welcome and long overdue. Still, Bishop (2014) cautions us not to “reify our labels”, since without fully understanding the biological basis for DLD, they are really just a collection of temporarily useful constructs. They may well change again in time, as our understanding of the nature and causes of these conditions evolves. Other researchers have advocated spending more time working on finding solutions, rather than focusing overly on labels. That’s something I’m happy to get behind.

    For more information about what a language disorder is, please see my blog post: https://secondaryschoolslt.wordpress.com/2026/01/02/what-is-developmental-language-disorder-dld/

    Notes

    Afasic, NAPLIC, RCSLT and Speech and Language UK (2023) A vision for Developmental Language Disorder (DLD) for the UK. ​

    Bishop, D.V.M. (2014). Ten questions about terminology for children with unexplained language problems. International Journal of Language & Communication Disorders, 49(4), pp. 381-415.

    Bishop DVM, Snowling MJ, Thompson PA, Greenhalgh T, CATALISE consortium (2016)

    CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children. PLoS ONE 11(7): e0158753.

    Bishop, D.V.M., Snowling, M.J., Thompson, P.A., Greenhalgh, T., and 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, 58(10), pp. ​ 1068–1080.

  • Do language disorders go away?

    In 2017, a panel of international experts described a language disorder as language difficulties that are likely to persist into middle childhood and beyond (Bishop et al, 2017). So, by definition, a language disorder is a condition that does not go away or resolve on its own. Indeed, there is now plenty of research suggesting that many early language difficulties endure into adolescence, and even adulthood.

    In one longitudinal study, Stothard et al (1998) found that two thirds of children who had impaired language skills at ages five to six continued to have significant difficulties at ages 15 to 16. And in Walter Loban’s groundbreaking study (1976), he found that the language abilities of his three groups remained surprisingly stable over time. That is, most of those in the high and low language ability groups stayed in those same groups all the way from kindergarten to Grade 12 and did not get much better or worse.

    Despite this evidence, there is a lot of misinformation and confusion surrounding this issue, even amongst professionals. In a series of online interviews conducted with young people with Developmental Language Disorder (DLD) and their families, many felt that their concerns were not taken seriously by General Practitioners (GPs), who claimed that “children often grow out of it” (RCSLT, 2023). Part of this confusion probably stems from the difficulties involved in diagnosing very young children.

    It is likely that a certain amount of normal variability exists in the language abilities of pre-schoolers. A child who begins talking late may be considered a “late bloomer” who does not have anything particularly “wrong” with them (Paul & Norbury, 2012). In fact, many children identified as “late talkers” around the age of 2 do catch up without any special help and go on to have normal language abilities (Bishop, 2014, Bishop et al, 2016).

    However, some do not. And other studies have found that even those who appeared to catch up with their peers were at continued risk later on in their development. For example, Rescorla (cited in Paul & Norbury, 2012) found in 2002 and 2009 that late talkers who were judged to have normal language abilities at ages 5 and 6 went on to display subtle, residual difficulties in language and literacy skills later on.

    The picture is unclear, and it is difficult to predict which late talkers will go on to have long-term problems and which will not (Bishop et al, 2017). However, the older the child is, the easier it is to judge. Whilst it is particularly difficult before the age of 3 (Bishop et al, 2017), Stothard et al (1998) noted that outcomes at 15 to 16 could be predicted fairly accurately by a child’s score at 5 to 6 years of age. A child identified at this point could be reasonably expected to have lifelong difficulties.

    But if a language disorder is a lifelong condition, then why don’t we treat it as one? Whilst Speech and Language Therapy (SALT) support for early years is widely available, along with a fair amount at primary school, this drops off considerably thereafter. Larson and McKinley (2003) found that only a fraction of older students were receiving services. And more recently, the Royal College of Speech and Language Therapists (RCSLT) (2023) observed that services were rationed, with little support available at secondary schools, and even less at further education colleges. No DLD services are currently provided for adults on the National Health Service (NHS).

    Early intervention may be effective (Paul & Norbury, 2012) in improving language skills, school success and longer term outcomes, but it is not a cure-all. In my opinion, the heavy emphasis placed on it risks undermining the need for ongoing support at different stages in a young person’s development.

    Larson and McKinley (2003) note that these early programs perform only part of the task, and that children’s difficulties are likely to re-emerge later, especially when the linguistic demands of a new context increase, such as in the transition to secondary school. They observe that discharging children in Year 6 only makes sense if the end goal is Year 6 level language skills.  

    Many experts in the field now advocate for services to be made available not just throughout childhood and adolescence, but also periodically throughout adulthood (RCSLT, 2023). This is something I feel strongly about, given the high costs to both the individual and society of not providing support.

    For more information on DLD, please see my post: https://secondaryschoolslt.wordpress.com/2026/01/02/what-is-developmental-language-disorder-dld/

    Notes

    Bishop, D.V.M. (2014). Ten questions about terminology for children with unexplained language problems. International Journal of Language & Communication Disorders, 49(4), pp. 381-415.

    Bishop DVM, Snowling MJ, Thompson PA, Greenhalgh T, CATALISE consortium (2016) CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children.

    Bishop, D.V.M., Snowling, M.J., Thompson, P.A., Greenhalgh, T., and 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, 58(10), pp. ​ 1068–1080.

    Larson, V.L. and McKinley, N.L. (2003) Communication solutions for older students. Thinking Pub. 

    Loban, W. (1976) Language Development: Kindergarten through Grade Twelve. Urbana, IL: National Council of Teachers of English.

    Paul, R. and Norbury, C. (2012) Language Disorders from Infancy Through Adolescence: Listening, Speaking, Reading, Writing, and Communicating. 4th edn. St. Louis, MO: Elsevier.

    Royal College of Speech and Language Therapists (RCSLT). “A Vision for Developmental Language Disorder (DLD) for the UK” London: RCSLT, 2023. https://www.rcslt.org/wp-content/uploads/2023/10/A-Vision-for-Developmental-Language-Disorder.pdf. 

    Stothard, S. E., Snowling, M. J., Bishop, D. V. M., Chipchase, B. B., & Kaplan, C. A. “Language-impaired preschoolers: A follow-up into adolescence.” Journal of Speech, Language, and Hearing Research 41, no. 2 (1998): 407-418.

  • Later language development: what Speech and Language Therapists need to know about the secondary school years

    Until relatively recently, the topic of later language development had been somewhat neglected. Whilst early childhood is seen as a time of rapid linguistic growth, later language development has been described as “gradual and protracted” (Nippold, 1998, p.3). Still, recent research has elucidated the many important advancements that occur during this period, calling into question the myth that language development is complete by school age.

    What’s normal?

    Whilst the early period is still considered the time of primary language acquisition, there is now a consensus that language development continues into adulthood and has no fixed end point. In the case of vocabulary, for example, even older adults may learn new words as they pursue different hobbies and read widely. On the other hand, some adults never master all grammatical structures, especially if they did not continue on to further education, where more scholarly forms are in more common usage (Nippold, 1998).

    Wide variation is thus characteristic of language development in the later years. As students begin secondary school, choose certain subjects, drop others, and take on extra-curricular activities, they also develop increasingly specialised vocabularies to match their interests: language becomes ever more individual to the student (Nippold, 1998). What’s more, with slang terms, hesitations, and non-specific phrases such as “like” and “stuff” increasingly common in adolescent language, even typical development may appear disordered (Larson and McKinley, 2003). Nippold (1998) points out that even well-educated adults make grammatical errors from time to time.

    These factors make it more difficult to set guidelines and to define what is “normal” during the adolescent years. And because change is slow and gradual, we may need to compare students across very different age groups to see the differences (Nippold, 1998, p.3).

    Walter Loban (1976) was the first person to document language growth into early adulthood through a longitudinal study comparing a low language ability group with a high language ability group. Since then, various other experts in the field have written about the topic, and a body of research now exists in the area. I have drawn mainly on the amazing work of Marylin Nippold in writing this blog post, particularly her book, “Later language development” (Nippold, 1998).

    Vocabulary

    One important development that occurs during the later years is the expansion of vocabulary. Whilst a 6 year old knows roughly 18,000 words, this increases to at least 60,000 in early adulthood (Nippold, 2024). As students progress through school and participate in the “literate” activities of reading, writing, academic discussion and accessing the curriculum, they begin to acquire more technical and specialist vocabulary, as well as concepts such as adverbs of magnitude and likelihood, and metacognitive and metalinguistic verbs (Nippold, 1998).

    Learning a word is also a gradual, rather than an all or nothing process (Nippold, 1998), and many qualitative improvements occur over time. As we encounter words in different contexts, semantic representations strengthen, and new meanings are added to words already in the repertoire: whilst a young child will typically know the physical meaning of a “double function” word such as “cold”, it is only later that she will learn its psychological meaning, and understand how these different meanings overlap (Nippold, 1998, p.15). Slowly, an organised semantic network develops, as connections between similar words are strengthened (Nippold, 1998).

    The way that we learn words also changes. When we are young, we learn words incidentally, through oral input, but when we begin secondary school, a lot of curriculum vocabulary is taught directly in class. Another important source of learning at this age is the written word, as students are exposed to more unusual, abstract and complex vocabulary and structures through their independent reading. Many young readers learn to utilise morphological and contextual clues to figure out the meanings of unfamiliar words they encounter, supported by developing metacognitive skills and a greater awareness of derivational morphology (Nippold, 1998).

    Syntax

    Syntax also develops in various, subtle ways. Considerable growth occurs at both the intrasentential1 and the intersentential2 levels. Individual sentences increase in length, complexity, and density of information (Nippold, 1998). Loban (1976) observed small, but regular increases in sentence length throughout the school years, although Nippold (1998) cautions us that the length of utterance depends very much on the context. All speakers tend to use shorter sentences when communicating in informal, conversational contexts, and longer sentences in more formal contexts, or when required to explain and give detailed information, such as when telling the rules of a game (Nippold, 1998, 2014).

    Clausal density is another sign of mature development. Whilst a 5 year old may be able to form grammatically correct sentences containing a range of subordinate clauses, the ability to construct longer sentences containing multiple, embedded subordinate clauses to express increasingly complex and abstract thoughts continues to develop into adulthood (Nippold, Mansfield, Billow and Tomblin, 2009). Improved understanding and use of a range of subordinating, coordinating and correlative conjunctions goes alongside this (Nippold, 1998).

    Certain types of clause, such as nominal, adverbial and relative clauses are also used increasingly (Nippold, 2024); the latter, in particular are a common sign of maturing language (Loban, 1976). For a detailed look at these, and other aspects of advanced grammar, I highly recommended Nippold’s book: “A grammar guide for Speech-Language Pathologists” (Nippold, 2014).

    Still, a long, clunky sentence is not necessarily a sign of mature language skills when the message could be expressed more succinctly. Loban (1976) found that during the later stages of adolescence, his low language ability group unexpectedly appeared to catch up with his high language group at one point, in terms of the average number of dependent clauses used per communication unit. However, upon deeper analysis, he found that the higher language group were using more sophisticated sentence structures which enabled them to be more concise.

    Rather than continuing to add on further clauses, sentences may be expanded in other ways, such as elaboration of noun and verb phrases through the use of appositives, infinitives, gerunds, prepositional phrases, and others. Indeed, the presence and combination of low-frequency syntactic structures such as these is another characteristic of mature language (Nippold, 1998). Students also learn to link different sentences together using adverbial conjuncts and other devices to produce cohesive discourse (Nippold, 1998).

    Discourse & comprehension

    Narratives are the most dominant type of discourse throughout primary school, and young children already know a lot about storytelling. At secondary school, students learn to construct longer, more detailed and organised narratives containing multiple episodes, whilst giving more space for their characters’ feelings and motivations. At the same time, other types of discourse, such as expository discourse3, persuasion and negotiation come to the fore (Nippold, 1998).

    Comprehension also improves slowly, and older children develop the important ability to process larger units of discourse (Nelson, 1998). Still, Larson and McKinley (2003) caution that we should not expect pre-adolescents and adolescents to understand everything we say to them, since some grammatical structures may not even be understood by adults. Anyone who has read complex academic prose can tell you that some sentences are just harder to understand than others.

    Figurative language & pragmatics

    Abstract thought, and with it figurative language such as similes, metaphors, idioms and proverbs also develops over time. Research has found that preschoolers have some awareness of this type of language, but that deeper understanding emerges during the school years and adolescence. Similarly, jokes, slang and ambiguous language become increasingly important, since they are linked to students’ self-esteem and peer-acceptance (Nippold, 1998). Conversational and pragmatic skills also develop, with older students more able to adapt their communication to different contexts (Nippold, 2024).

    Whilst many linguistic achievements appear to be “built in”, we have seen how school itself, and the contexts in which students find themselves can influence language development. Similarly, the increasing demands of formal education, which typically include reading challenging material, and extended written assignments sometimes requiring independent research may push forward cognitive and linguistic growth (Paul and Norbury, 2012, Nippold, 2024). As Nippold says, “complex thought encourages complex talk” (Nippold, 2014).

    Final thoughts

    Despite the amount of research now available, later language development is still widely ignored. Larson and McKinley (2003) found that very few university programs across the USA offered modules on this topic, and my experience at a UK university in 2012 was similar. In a small survey that I carried out last year, around half of my fellow SLTs did not feel they had the knowledge to work with this age group, with a further 25% feeling unsure, suggesting that perhaps not much has changed. I hope this summary has helped; for a more in-depth look at later language development and a deeper understanding of grammar, I highly recommend Marilyn Nippold’s excellent books (Nippold, 1998, 2023).

    To find out more about what a language disorders might look like in the later years, please see my post: https://secondaryschoolslt.wordpress.com/2026/01/07/what-is-developmental-language-disorder-dld/

    Notes

    Larson, V.L. and McKinley, N.L. (2003) Communication solutions for older students. Thinking Pub. 

    Loban, W. (1976) Language Development: Kindergarten through Grade Twelve. Urbana, IL: National Council of Teachers of English.

    Nelson, N. W. (1998) Childhood Language Disorders in Context: Infancy Through Adolescence. 2nd edn. Boston, MA: Allyn & Bacon.

    Nippold, M.A. (1998) Later language development: The school-age and adolescent years. 2nd ed. Austin, TX: Pro-Ed.

    Nippold, M. A., Mansfield, T. C., Billow, J. L. and Tomblin, J. B. (2009) ‘Syntactic development in adolescents with a history of language impairments: a follow-up investigation’, American Journal of Speech-Language Pathology, 18(3), pp. 241–251. 

    Nippold, Marilyn. (2014). Language Intervention at the Middle School: Complex Talk Reflects Complex Thought. Language, Speech, and Hearing Services in Schools. 45. 153-156. 10.1044/2014_LSHSS-14-0027.

    Nippold, M.A. (2023). Grammar guide for speech-language pathologists: Steps to analyzing complex syntax. San Diego: Plural Publishing.

    Nippold, Marilyn. (2024). Language Development in School-Age Children, Adolescents, and Young Adults. 10.1016/B978-0-323-95504-1.00374-4.

    Paul, R. and Norbury, C. (2012) Language Disorders from Infancy Through Adolescence: Listening, Speaking, Reading, Writing, and Communicating. 4th edn. St. Louis, MO: Elsevier.

    1. Within sentences ↩︎
    2. Between sentences ↩︎
    3. Discourse aiming to explain or inform; this is the language of the classroom, of lectures, textbooks, reports, etc.  ↩︎

  • What causes language disorders?

    In the relatively short history of our field, much has been learned about language development and what is considered “normal” at different stages. This research, leading to the creation of a kind of “syllabus” to be followed, has allowed SLTs to carry out much of the work that we do (Paul & Norbury, 2012). However, we are still some way from understanding the precise nature of language disorders and their underlying causes. Here’s what we do know.

    There’s a general consensus that most cases of language disorder are likely due to a combination of genetic and environmental factors (Bishop, 2014). Family studies, especially twin studies have revealed that language disorders are highly heritable and tend to run in families.

    In 2001, researchers even found that a single disordered gene, FOXP2 caused a severe speech and language disorder in three generations of one family (Paul & Norbury, 2012, p. 3). However, it does not seem to be associated with more common forms of Developmental Language Disorder (DLD). Paul and Norbury (2012) also point out that genes do not directly encode behaviour, so searching for a specific “language gene” makes little sense. It is more likely that several are involved.

    Other research has highlighted the importance of environmental factors. The strong association between socio-economic status (SES) and language ability is well-established (Bishop, 2014). Many studies over the years have revealed that individuals in high SES groups are more likely to have strong language abilities, whilst those in disadvantaged, low SES groups are more likely to have weaker language skills (Loban, 1976).

    Roy and Chiat (2013) note that those in low SES groups are disproportionately affected by language disorders. They observe that SES status affects children’s outcomes through the quality of the physical and psychological environments that they experience. Whilst SES status is typically based on indices such as the main carers’ education and income levels, other factors such as exposure to toxins and stress, nutritional intake, parenting style and cognitive stimulation often go alongside poverty and SES.

    Similarly, the language input we receive when we are young is likely to influence the course of our development. In one study, it was found that children in a low SES “welfare” group heard only a quarter of the words that those growing up in professional families heard in a week (Roy and Chiat, 2013).

    However, there may be more to this than meets the eye. Language ability is likely to affect SES categorization in the first place, since those with language disorders are less likely to go on to formal education, and more likely to be unemployed or “underemployed” (Larson and McKinley, 2003). What we assume to be the effects of poverty may in fact be related to undiagnosed parental language disorders. In other words, the heritable aspect of these situations may have been overlooked.

    (For more information about whether there is a difference between language disadvantage and language disorder, please see my blog post: https://secondaryschoolslt.wordpress.com/2026/03/06/language-disorders-is-there-a-difference-between-disadvantage-and-disorder/ .)

    This is not to say that our surroundings have no influence. We know from fields such as medicine that our environments are capable of influencing gene expression, brain structure and functioning. Leveraging the positive effects of the environment is what allows intervention to work, and changes in the gray matter or the brain have even been observed following Speech and Language Therapy (SALT) (Paul and Norbury, 2012).

    Language disorders, then, do not have a single cause. Instead, it seems likely that multiple interacting risk factors co-occur to give rise to the pattern of difficulties seen in DLD (Paul & Norbury, 2012). How these factors affect the brain is another question. But whatever the precise mechanisms involved, it does seem that the brains of people with DLD are wired differently.

    Whilst DLD is not associated with gross lesions in the brain, recent neuroimaging studies have identified subtle differences in cerebral volume, symmetry and blood flow in those affected (Abbot and Love, 2023). The research is still limited and often conflicting, but there has been some consensus across a few areas.

    Firstly, a part of the brain called the “planum temporale”, located in the temporal lobe has been theorized to be involved in language processing. In typically developing individuals, this region is usually bigger on the left-hand side, but those with DLD tend to have more symmetrical brains, and in some, it is actually larger on the right. Some researchers have attributed this to the brain compensating for some deficiency on the left-hand side (Abbot and Love, 2023).

    Differences in the gray and white matter around other regions associated with language such as the inferior frontal gyrus and caudate nucleus have also been observed. Reduced blood flow and activation of these areas was found in tandem. Finally, the brains of individuals with DLD were found to be smaller overall (Abbot and Love, 2023).

    Many questions remain. Exactly how do these differences map onto the behaviours that we see? Do structural brain differences cause language disorders, or could a different type of functioning associated with language disorders lead to observable differences over time? Some studies also revealed that whilst most parents of children with DLD had similar atypical brain structures to their offspring, they did not all exhibit the same difficulties, further confusing the issue (Paul and Norbury, 2012). Despite all of these discoveries, the connection between the brain and the difficulties we see in DLD remains unclear.

    For a discussion around which terminology to use, please see my post: https://secondaryschoolslt.wordpress.com/2026/02/26/developmental-language-disorder-a-brief-history-of-terminology/

    Notes

    Abbott, N., & Love, T. (2023). Bridging the Divide: Brain and Behavior in Developmental Language Disorder. Brain Sciences, 13(11), 1606.

    Bishop, D.V.M. (2014). Ten questions about terminology for children with unexplained language problems. International Journal of Language & Communication Disorders, 49(4), pp. 381-415.

    Larson, V.L. and McKinley, N.L. (2003) Communication solutions for older students. Thinking Pub. 

    Loban, W. (1976) Language Development: Kindergarten through Grade Twelve. Urbana, IL: National Council of Teachers of English.

    Paul, R. and Norbury, C. (2012) Language Disorders from Infancy Through Adolescence: Listening, Speaking, Reading, Writing, and Communicating. 4th edn. St. Louis, MO: Elsevier.

    Roy, P. and Chiat, S. (2013). Teasing apart disadvantage from disorder The case of poor language. In: Marshall, C. R. (Ed.), Current Issues in Developmental Disorders. Current Issues in Developmental Psychology. (pp. 125-150). PSYCHOLOGY PRESS.

  • What is Developmental Language Disorder (DLD)?

    Say the words “dyslexia”, “autism”, or “ADHD”, and most people will have a reasonable idea of what you are talking about. But say the words “Developmental Language Disorder” to a random member of the public, and you’re likely to be met with a blank stare. Despite international efforts to raise awareness, understanding of the condition remains low amongst healthcare and educational professionals, and it’s even lower amongst the general public (RCSLT, 2023).

    Yet 2 children in every class of 30 are likely to have language difficulties severe enough to affect their academic progress (Norbury et al, 2016). These children may struggle to follow their teachers’ instructions, to understand what’s going on in their lessons, to find the right words, to communicate their thoughts verbally and in writing, or to socialize with peers.

    As young children, they may have been “late talkers” (although just as many were not…) and they may have been slow to combine words into sentences. Errors that typically go away, such as over-regularisation of the past tense, or missing off the third person singular marker may persist. Growing older, many continue to make the grammatical errors and present with the language skills of much younger children.

    For some, their difficulties are only noticed later on, perhaps as they begin to struggle in primary, or secondary school. In addition to the difficulties mentioned above, these students may find it hard to formulate complex and compound sentences containing a range of conjunctions, to understand connected text, and to complete assignments. They are likely to go on to become adults unable to communicate with accuracy, clarity and efficiency (ACE) (Nippold, 2023).

    The consequences of not receiving support are well documented. Students with language disorders find it harder to access the curriculum, to form friendships and to follow the unspoken routines of school. Many will experience a growing sense of frustration at being unable to communicate and understand, and they are more likely to suffer from low self-esteem (Nelson, 1998).

    Some students respond by “acting out” and causing disruption in their lessons, perhaps to avoid the work that they find increasingly difficult, or to avoid being seen as “stupid”; others respond by shutting down, sitting quietly at the back with no clue what is going on. Many will find themselves labelled as “naughty” or “lazy” as a result, and these students tend to be in trouble frequently at school. Many will experience school failure (Nelson, 1998).

    As adults entering the workforce with fewer qualifications, personal resources and often associated reading and writing difficulties, many will find themselves unemployed or underemployed (Larson and McKinley, 2003). They are at greater risk of mental health difficulties (Nippold, 2018), and even juvenile offending (Larson and McKinley, 2003).

    I wanted to paint a picture of what language disorders can look like above. But so far, we have only discussed the surface level symptoms. We haven’t said what they are. So, then, what causes language disorders, what is going on underneath, and how should we define them? I felt that there were too many facets of the topic to deal with in one blog post, so I decided to write a series of posts.

    To find out what causes language disorders, please see my next post: https://secondaryschoolslt.wordpress.com/2026/01/05/what-causes-language-disorders/

    Notes

    Larson, V.L. and McKinley, N.L. (2003) Communication solutions for older students. Thinking Pub. 

    Nelson, N. W. (1998) Childhood Language Disorders in Context: Infancy Through Adolescence. 2nd edn. Boston, MA: Allyn & Bacon.

    Nippold, Marilyn A. “The Literate Lexicon in Adolescents: Monitoring the Use and Understanding of Morphologically Complex Words.” Language, Speech, and Hearing Services in Schools 49, no. 4 (October 2018): 718–30.

    Nippold, M.A. (2023). Grammar guide for speech-language pathologists: Steps to analyzing complex syntax. San Diego: Plural Publishing.

    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, 57(11), pp. 1247–1257.

    Royal College of Speech and Language Therapists (RCSLT). “A Vision for Developmental Language Disorder (DLD) for the UK” London: RCSLT, 2023. https://www.rcslt.org/wp-content/uploads/2023/10/A-Vision-for-Developmental-Language-Disorder.pdf. 

  • In at the deep end

    I began my Speech and Language Therapy journey sobbing in the Additional Learning Needs room in the autumn term of 2014. It was the beginning of the academic year and I’d just gotten my first job as a Newly Qualified Practitioner (NQP) at an “academy” in a deprived borough of London. Unusually for a mainstream secondary school, they’d hired a private Speech and Language Therapist – me! – to manage their huge caseload of around 100 students with language and communication needs. And I didn’t seem to be handling it all that well…

    “I get on well with teenagers”, I’d said during the interview, “and since everyone’s so focused on early intervention, I think they can get forgotten about. But I feel they deserve to be supported too…” That’s how I found myself leading (in the loosest sense of the word) seven Speech and Language Therapy sessions a day – for groups of disengaged young people who seemed keener on throwing the bean bag I’d brought as a “talking stick” at each other’s heads than in doing any of the activities I’d carefully planned.

    It didn’t help that I’d never worked in a secondary school before, let alone had a placement in one. Or that my postgraduate course back in 2012 had covered early language development, before moving swiftly onto acquired adult conditions, all but skipping the adolescent period. Although research into this age group is slowly building, it’s still only a fraction of what’s available for early years. You could be forgiven for thinking that language development ends at 5, and there’s nothing left to be done…

    On the contrary, as student after student came through my door for their assessments, a staggering level of need emerged that I’d never have expected to find in this ordinary secondary school. Many were struggling with basic sentence structures and vocabulary, yet they were expected to analyse Shakespearean tragedies and compose essays. The gap between where my students were and where they were expected to be seemed insurmountable – was it really my job to help them cross it?

    Meanwhile, as the only SLT at school, I had to wait for my weekly supervision session at the clinic for a sighting of one of my colleagues. This made for a slightly strange and isolating first year. And without anyone to ask advice on a daily basis, my students became a mirror for how I was doing. The reflection wasn’t always flattering. They’d often “act out” or refuse to come to my sessions. This was tough, but looking back, it was some of the clearest and most honest feedback I ever received.

    I only ended up staying at that first school for a year, but I did stick with the age group. Over the next decade I went on to work at a range of mainstream secondaries around London, mainly privately, but also as a locum for the NHS.

    Slowly, things started to get better, and I began to see my own progress reflected in my students. Their annual CELF-5 scores improved. They’d tell me that they were understanding more in class; that they were finding it easier to follow their teachers’ instructions. A memory strategy helped one remember his mum’s PIN so he could help her with the shopping (so he said!). Another would proudly show me his conduct card at the beginning of every session with admittedly fewer infractions than the previous term.

    But most of all, my students began showing up more – physically and mentally – to my sessions. And overwhelmingly they did so without complaining; it was almost as if they thought it was helping!

    I’m not a researcher or academic – just an ordinary SLT who’s been in the extra-ordinary position of having time, week in, week out, to try out a range of interventions with my students to see what worked. It’s taken a lot of trial and error, digging out random books and taking obscure courses to get to a point where I feel like I’m truly serving my students’ needs.

    My practice is by no means perfect, but I wanted to start this blog to pass on what I’ve learnt, and to share a window into my practice for anyone who’s interested. Whether you’re a student, SLT or another professional interested in finding out more, I hope this helps.

    Tawna

    You might like to start here: https://secondaryschoolslt.wordpress.com/2026/01/07/what-is-developmental-language-disorder-dld/