Developmental language disorder (DLD)

What it is

Lasting difficulty understanding and/or using spoken language that is not explained by hearing loss, autism, or another condition.

Common experiences

May appear as trouble following instructions, finding words, or telling stories, and is frequently overlooked.

What helps

Short, clear instructions, visual supports, extra processing time, and speech-language therapy.

Across life

Children may talk late, use short sentences, struggle to learn new words, or have trouble following directions. At school it can be mistaken for inattention or behavior problems. It often continues into adulthood.

Evaluation and treatment

A speech-language pathologist (speech and language therapist) assesses it. Therapy and classroom supports such as visuals, repetition, and chunked instructions help.

Myth vs fact

Myth: children with language difficulties always catch up on their own. Fact: many late talkers do catch up without special help, but children at greatest risk of persisting problems are those with poor language comprehension, limited use of gesture, or a family history of language impairment, and severe difficulties affecting both understanding and expression are more likely to persist. A speech-language assessment can show which applies (Bishop et al., 2016).

Full chapter

Definitions and terminology

A multinational, multidisciplinary expert consensus known as CATALISE (Bishop et al., 2016, 2017) recommends the term developmental language disorder (DLD) for language disorder with no known differentiating condition. Language disorder here means language problems that create barriers to communication or learning in everyday life and are likely to continue into middle childhood and beyond. Differentiating conditions include brain injury, genetic conditions such as Down syndrome, sensorineural hearing loss, cerebral palsy, autism, and intellectual disability (Bishop et al., 2017). Other neurodevelopmental conditions do not rule DLD out: attention problems (ADHD), motor problems (developmental coordination disorder), and reading and spelling problems (dyslexia) can occur alongside it (Bishop et al., 2017). DLD replaces older terms such as specific language impairment, and you may still hear language delay or language disorder used in clinics and schools.

How the DSM-5-TR and ICD-11 describe it

The DSM-5-TR calls the broader diagnosis language disorder: lasting difficulties acquiring and using language, in spoken, written, or other forms, because of problems understanding or producing language. Language abilities must be substantially below what is expected for age and limit communication, social participation, school, or work. The difficulties begin in the early developmental period and are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition, and are not better explained by intellectual disability or global developmental delay. The ICD-11 uses the name developmental language disorder, with subtypes for impairment of receptive and expressive language, of mainly expressive language, of mainly pragmatic language, and of other specified aspects of language, and it excludes autism spectrum disorder. The DSM-5-TR diagnoses difficulties with the social use of language, without restricted and repetitive behaviors, separately as social (pragmatic) communication disorder.

What DLD looks like

DLD can affect understanding language, using it, or both. Understanding difficulties include following spoken instructions, grasping grammar, and working out what is meant. Expression difficulties include finding the right word, learning new vocabulary, building sentences, and telling a story or explaining something in order. Pragmatic difficulties, such as taking turns in conversation, staying on topic, or judging what a listener needs to know, can also occur, and the ICD-11 recognizes a mainly pragmatic subtype. Difficulties are often most visible when language demands rise, for example with long instructions, abstract vocabulary, or fast group conversation.

How common it is and what causes it

In a population study of children starting primary school in Surrey, England, about 7.6 percent had language disorder of unknown origin, the group now called DLD, which is roughly 1 in 13, or two children in a class of 30. About 9.9 percent had language disorder when children with other conditions were included (Norbury et al., 2016). A family history of language impairment is one of the recognized risk factors for language problems that persist (Bishop et al., 2016), and a twin study pointed to a genetic contribution (Bishop et al., 1995). Bilingualism does not cause DLD (Paradis et al., 2021). DLD is a neurodevelopmental condition; it is not a sign of poor parenting, laziness, or lack of effort.

Signs across ages

Many late talkers catch up without special help. Those at greatest risk of persisting problems are late talkers with poor language comprehension, limited use of gesture, and/or a family history of language impairment (Bishop et al., 2016). CATALISE also notes that children's language can change dramatically in the preschool and early school years even without intervention, and that severe language impairment affecting both understanding and expression is more likely to persist (Bishop et al., 2016). From age 5 upward, CATALISE lists these as indicators of atypical language development: difficulty telling or re-telling a coherent story, difficulty understanding what is read or heard, marked difficulty following or remembering spoken instructions, talking a lot but being poor at reciprocal conversation, and many over-literal interpretations of what others mean (Bishop et al., 2016). At school these can show up as trouble with multi-step directions, learning vocabulary, and explaining ideas. Teens and adults may find phone calls, interviews, group discussion, and complex spoken instructions especially demanding.

A hidden difference

DLD is easy to miss because the person may seem bright, sociable, and able to speak fluently, and because difficulties can be mistaken for inattention, shyness, or defiance. Part of the problem has been inconsistent labelling. There was little agreement about the terms and criteria used to identify and classify language impairments in children, with specific language impairment, language delay, developmental language disorder, and developmental dysphasia all in use, which is why CATALISE recommended a single term (Bishop et al., 2016, 2017).

DLD and other differences

ADHD, developmental coordination disorder (dyspraxia), and dyslexia can all occur alongside DLD, and having another neurodevelopmental diagnosis does not rule DLD out (Bishop et al., 2017). In one study that followed children from age 5 to age 19, those with early language impairment had significantly higher rates of anxiety disorder in young adulthood than those without (Beitchman et al., 2001). A thorough assessment looks at hearing, language, reading, attention, motor skills, social communication, and mental health.

Bilingual and multilingual children

Bilingualism does not cause DLD, and children with DLD can learn more than one language (Paradis et al., 2021). CATALISE notes that for children learning English as an additional language it can be hard to tell whether poor English reflects a genuine language problem or limited exposure to English. Where there is a language problem, it will be evident in the home language or languages, although assessing those directly may not be feasible (Bishop et al., 2016). Assessment should therefore consider all of a child's languages, ideally with an interpreter or clinician who speaks them, and families do not need to stop using their home language.

Learning, friendships, and wellbeing

Language underpins learning and friendship, so DLD can affect both. At age 11, children with specific language impairment in one study were more likely to be victimized by peers and to have social difficulties (Conti-Ramsden & Botting, 2004), and adolescents with a history of the condition reported more emotional difficulties than their peers in another (Conti-Ramsden & Botting, 2008). Understanding teachers, patient communication partners, and support for social communication can help protect wellbeing. If you are struggling emotionally, the Crisis help page lists where to turn.

Into adulthood

DLD can last into adulthood. A follow-up of adults who had had severe developmental language disorder in childhood found persisting language, literacy, and psychosocial difficulties (Clegg et al., 2005), and a UK study found poorer education and employment outcomes among young adults with a history of DLD (Conti-Ramsden et al., 2018). Adults often benefit from written instructions, extra time in interviews and meetings, and workplaces that value clear, plain communication.

Getting assessed

A speech-language pathologist (speech and language therapist) assesses understanding and use of language through standardized tests, such as the CELF-5 (Wiig et al., 2013), and through conversation and storytelling samples, and usually checks hearing and considers developmental history. For young children, CATALISE stresses that language can change dramatically in the preschool years, so assessment should weigh risk factors for persistent problems, such as poor language comprehension, limited gesture, and a family history of language impairment (Bishop et al., 2016). Because DLD can occur with other differences, a broader assessment may involve a psychologist, a pediatrician, and an occupational therapist. Rules about who can diagnose and how services are funded vary by country.

Speech-language therapy

A Cochrane systematic review of trials of speech and language therapy for children with primary speech and language delay or disorder found positive effects for expressive vocabulary and expressive phonology, mixed findings for expressive syntax, and too little evidence to draw conclusions about therapy for receptive language, which the authors said needs more research (Law et al., 2003). That review dates from 2003, so ask a speech-language pathologist about newer evidence. A randomized trial of 216 children aged 6 to 9 with language impairments found that children improved in all four conditions it compared, and that the commercial computer program Fast ForWord Language was no more effective than the other treatments (Gillam et al., 2008). Whatever approach is used, it is reasonable to ask the therapist which skills are being targeted and how progress will be measured.

Supports at school and work

These are commonly recommended practical supports, not findings from a single study. Helpful supports include short, clear instructions given one step at a time, visual supports such as schedules and pictures, checking understanding by asking the person to show or explain rather than asking whether it was clear, pre-teaching key vocabulary, extra time to process and respond, and written follow-ups. At work, plain-language emails, agendas before meetings, and the option to respond in writing can remove barriers. The Toolkit page includes communication cards and a visual schedule builder.

School, work, and rights

In the United States, speech or language impairment is a named disability category under the IDEA (34 C.F.R. 300.8(c)(11)), and Section 504 and the ADA provide accommodations at school and work. In the UK, the Equality Act 2010 requires reasonable adjustments, and in Canada provincial and territorial human rights codes require accommodation to the point of undue hardship. Useful adjustments include speech-language services, extra time, instructions in writing, and alternatives to spoken presentations. Laws and eligibility vary, so confirm locally, and see the Resources page.

Identity and being understood

DLD is not laziness, rudeness, shyness, or poor parenting. Some people with DLD say they know what they want to say but cannot find the words, or are unsure what was asked. A shared name helps people explain their needs and find others with similar experiences.

For families, teachers, and colleagues

Slow down, use plain words, and give one instruction at a time. Pair spoken words with gestures, pictures, or writing, check understanding in a respectful way, and give time to answer without finishing sentences. Do not assume that a quiet or off-task person is not trying. Praise effort, support friendships, and ask a speech-language pathologist for strategies. The Resources page lists RADLD and other organizations.

Sources

1. American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).
2. World Health Organization. International Classification of Diseases, 11th Revision (ICD-11), section on developmental language disorder (6A01.2).
3. Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & the CATALISE Consortium. (2016). CATALISE: A multinational and multidisciplinary Delphi consensus study. Identifying language impairments in children. PLoS ONE, 11(7), e0158753.
4. Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & 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), 1068-1080.
5. Norbury, C. F., et al. (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), 1247-1257.
6. Bishop, D. V. M., North, T., & Donlan, C. (1995). Genetic basis of specific language impairment: Evidence from a twin study. Developmental Medicine & Child Neurology, 37(1), 56-71.
7. Paradis, J., Genesee, F., & Crago, M. B. (2021). Dual Language Development and Disorders: A Handbook on Bilingualism and Second Language Learning (3rd ed.). Paul H. Brookes Publishing.
8. Beitchman, J. H., et al. (2001). Fourteen-year follow-up of speech/language-impaired and control children: Psychiatric outcome. Journal of the American Academy of Child & Adolescent Psychiatry, 40(1), 75-82.
9. Conti-Ramsden, G., & Botting, N. (2004). Social difficulties and victimization in children with SLI at 11 years of age. Journal of Speech, Language, and Hearing Research, 47(1), 145-161.
10. Conti-Ramsden, G., & Botting, N. (2008). Emotional health in adolescents with and without a history of specific language impairment (SLI). Journal of Child Psychology and Psychiatry, 49(5), 516-525.
11. Clegg, J., Hollis, C., Mawhood, L., & Rutter, M. (2005). Developmental language disorders: A follow-up in later adult life. Cognitive, language and psychosocial outcomes. Journal of Child Psychology and Psychiatry, 46(2), 128-149.
12. Conti-Ramsden, G., Durkin, K., Toseeb, U., Botting, N., & Pickles, A. (2018). Education and employment outcomes of young adults with a history of developmental language disorder. International Journal of Language & Communication Disorders, 53(2), 237-255.
13. Wiig, E. H., Semel, E., & Secord, W. A. (2013). Clinical Evaluation of Language Fundamentals, Fifth Edition (CELF-5). Pearson.
14. Law, J., Garrett, Z., & Nye, C. (2003). Speech and language therapy interventions for children with primary speech and language delay or disorder. Cochrane Database of Systematic Reviews, (3), CD004110.
15. Gillam, R. B., et al. (2008). The efficacy of Fast ForWord Language intervention in school-age children with language impairment: A randomized controlled trial. Journal of Speech, Language, and Hearing Research, 51(1), 97-119.
16. Individuals with Disabilities Education Act regulations, 34 C.F.R. 300.8(c)(11) (speech or language impairment).
17. Equality Act 2010 (United Kingdom).

Citations are listed so you can verify claims and read further. Guidance is revised over time, so check for newer editions.