Exploring Primary Language Disorder
Since my commencement in a leadership role at The Glenleighden School questions which have continued to arise from parents, staff and the general community have had a common focus – understanding the difference between autistic spectrum disorders (ASD), intellectual impairments or global developmental delays, and specific language impairments or primary language disorders. Differential diagnosis between autistic spectrum disorders and specific language impairments/primary language disorders remains a complex issue world-wide. Let’s start with some definitions.
The majority of children diagnosed with autism also have an intellectual impairment, ranging from mild to profound levels of difficulty. And while all children with autism would be deemed to have a qualitative impairment in their social interactions, the nature of their communication impairments can vary widely from a total lack of spoken language to marked impairment in their ability to sustain a conversation with others. It is important to note that children diagnosed with Asperger’s syndrome, included in ASD, do not generally present with a delay or deviance in early language development at all. Children diagnosed with ASD whose social skills and behaviour are considered to be at the milder end of the continuum may present with severe to profound language difficulties which are a greater impediment to their educational and developmental achievements than their social interaction difficulties and which may confound the diagnosis provided for the child.
Current genetic and neurodevelopmental research suggests there is no genetic or neurological link between autism and specific language impairment, making it necessary to carefully consider the approaches and responses to intervention where co-morbidity (i.e. the existence of two or more disabilities) is present. The funding model used by the Department of Education does not accept co-morbidity between the funding categories of Speech Language Impairment and ASD or Intellectual Impairment, while the literature is less definitive about this.
CHI.L.D. Association takes a best practice perspective on this issue. We accept that primary language disorder can co-exist with other disabilities, presenting as a significant and primary obstacle to learning and development than would be otherwise expected given the degree and impact of any other impairments. Sometimes, this is difficult to assess, however the provision of specific, targeted, quality intervention for language and attention for some children provides better insight into children’s capacities and primary difficulties than a one-off screening or assessment. This is why we believe in the best quality early intervention services, specifically targeting language and associated difficulties, as provided through the LET’S TALK Developmental Hub. It is also why we offer the benefit of the doubt to a number of children offered a place at The Glenleighden School, particularly in Early Childhood, and encourage an open dialogue with parents with regards to a child’s progress in at least the first twelve months of placement. A child’s response to an individualised and targeted intervention program will provide a wealth of information about the underlying nature of a child’s difficulties.
To clarify, Glenleighden can offer placements to children and adolescents with a primary language disorder who also have a diagnosis of and/or a funding allocation under ASD or intellectual impairment if the enrolment team deem that the language difficulties are the primary impediment to a child’s learning and that to the best of their knowledge that the school is able to provide interventions which will make a significant difference to a child’s learning and the school can support any co-existing impairments within the resources they have available. This criteria continues to be used when children’s ongoing suitability for placement is discussed with parents.
Similarly, the LET’S TALK Outreach program can also provide support to schools that have children funded under other disability categories if language is deemed to be the primary impediment to learning. And while the LET’S TALK clinic services provide a wider scope of support, the focus remains on communication and associated difficulties, with children whose primary difficulties being other than language being referred on to more appropriate services for ongoing support.
While it may be nice to have distinct boxes to place children in, the nature of human beings and their development is of such beauty and complexity that lines and shadows and shape changing is a more apt analogy. By keeping ourselves informed of the similarities and differences between primary language disorder and other developmental disabilities, and providing opportunities for children to demonstrate their capacity in programs targeting their language and communication skills, we are better able to assist parents and politicians to make decisions now and in the future which impact significantly on the quality of life of our children and their families.
Vikki Rose Graydon