How many children in your class have developmental language disorder (DLD)? The answer may be more than you think. According to research published in 2016 by Courtenay Norbury, a professor of developmental language and communication disorders at University College London, around 7.5 per cent of children have DLD - that’s the equivalent of around two children in a class of 30.
DLD is to speaking and listening what dyslexia is to writing: children who experience it have severe, persistent difficulties understanding or using spoken language. This, understandably, can have a negative impact on their learning. But new research suggests that early language difficulties can also lead to social, emotional and behavioural problems, and have an impact on mental health.
Norbury has been researching DLD for the past decade through the SCALES (the Surrey Communication and Language in Education Study) project, which tracks children who have difficulties with language when they start school and follows them through their educational journey.
The impact of developmental language disorder in schools
Here, she and her colleague, Sarah Griffiths, a senior research fellow at UCL, talk to Tes about new findings from SCALES, which specifically relate to the emotional effects of DLD.
Tes: What do we know about the connection between early language difficulties and social, emotional and behavioural problems?
Norbury: We’ve known for a while that there is an association between early language difficulties and later social, emotional and behavioural (SEB) issues: children with language disorders are at about twice the risk of having SEB problems than those who don’t. We are also aware that these problems seem to be elevated when children go to secondary school.
Tes: Your latest research adds to that understanding. Can you explain how?
Norbury: This research looked at how language might affect the skills that you need to maintain wellbeing. In particular, around understanding your own and other people’s emotions, and also regulating your own emotional states.
Most people, when in a stressful situation, use self-talk to regulate anxiety, worry, stress, and can talk to others for support. We wanted to see if children with DLD were able to do this, and if not, what that meant for their mental health.
Tes: How did you test this?
Griffiths: We asked around 380 children of all abilities to perform two tasks. The first tested children’s ability to recognise emotions from people’s faces, and from sounds that people made.
The second task tested the use of an emotion regulation strategy called temporal distancing, which is when you reflect on how you’ll feel about a certain scenario in the future to reduce negative emotion. It’s about putting things into perspective.
If, for example, your holiday was cancelled because of Covid, you’d be really upset about it. But you might feel better if you thought about how you would feel about it in a year. You might think, well in a year’s time, hopefully things will be different and I’ll be able to go on holiday.
We asked children to rate their emotion before and after they’d listened to different scenarios and had taken a distancing perspective. If children still felt the same after using the strategy, we took that to mean that they were not effective at regulating their emotion.
Tes: What did you find out?
Griffiths: We looked at how early language predicted performance on both emotion tasks, and found that children who had poorer early language performed less well on the emotion recognition and regulation tasks at the end of primary school. We also compared the results of children with DLD against those without, and found that the former group struggled to recognise the emotions.
This may be because they struggle to access the language to describe the emotions they witness and feel. Language allows you to create more nuanced categories of emotion. So children who don’t have that language, who aren’t engaged in that discussion, aren’t going to be developing that kind of nuance.
Without language, you might know that you are either happy or not, but the shades of not happy, sad, disappointed, disgusted, annoyed are lost - and that will disrupt your understanding of a lot of things, including recognising and regulating emotion.
Tes: Why does it matter whether a child can recognise and regulate emotions or not?
Griffiths: Being able to regulate and recognise emotions is important for mental health. If you can’t recognise other people’s emotions, you are then going to find it more difficult to interact with other people and make friends, which we know can be difficult for children with language disorders anyway.
Norbury: I’d add that any children with language disorder found the temporal distancing task, in particular, really challenging. This is interesting because many interventions within child and adolescent mental health services (Camhs) rely on verbal strategies, which require children to think about potential future scenarios and how to deal with those. These findings suggest that for children with language problems, those strategies are going to be very difficult to access.
Tes: Are there things that teachers can do in the classroom to help children with language difficulties get better at recognising and responding to emotions?
Norbury: I think language interventions could have a more direct focus on language for wellbeing. For example, if the intervention is focused on vocabulary development, maybe we could include more words that describe emotions and the contexts in which those emotions are likely to occur, and then scaffold the use of this new vocabulary for the purposes of emotional regulation or recognising emotion.
Griffiths: We see lots of programmes in schools about improving children’s emotional competence and mental health, but they’re often just given across the board to all children without thinking about what prerequisite skills they need to access those programmes.
If you don’t have the vocabulary or grammatical skills to understand the scenarios which would make you feel a certain way, and what you might then do about it, you’re not getting that learning about emotion because of your language difficulties.
We need to tailor the intervention to children who have poor language by reducing the language demands, but also focus on the language skills that allow them to access those interventions. It’s not just about vocabulary, it’s also about teaching syntax, phrases like “they think”, “she says” and “he feels” to keep track of complex sentences.
Norbury: Teachers could also model the language that we all use for regulation by being verbally explicit about their strategies and problem-solving skills, and then reinforce those strategies with visual cues.
For example, with very young children, we often talk about other people’s emotions: “Don’t hit your brother, he feels sad when you hit him.” There are older children with language disorders who still need that level of explicit talk. Think out loud, and model for children how to use language to navigate that emotional space.
Tes: How can teachers spot the children who need this level of extra support?
Norbury: We talk about there being a minimum threshold of “good enough language” - beyond this threshold, having more words and complex sentences doesn’t necessarily equal better mental health. However, when children are below the threshold, their language deficit is severe, and so the risk of ill mental health increases.
Spotting those below the threshold is tough: it can look quite different from child to child. Teachers will be aware of some children who have problems with language, but there will also be children with language disorders who just are not on the radar, because they’re very quiet and they’re not engaging.
Be on the lookout for those who maybe aren’t included in their peer group, as well as children who are really struggling with reading or maths, who look like they’re not listening a lot of the time. They might be fidgeting, distracting themselves; it’s not because they’re naughty, it could be because they don’t understand what’s going on.
All of these children are at risk. It’s also worth noting that children who have multiple things going on - the children who have other diagnoses, who have behaviour problems, who have more challenges at home - will be in that high-risk group, too.
Tes: So, to be safe, should teachers assume that every child who struggles with language will also have poor mental health?
Griffiths: No, definitely not. It’s an increased risk, but the vast majority of children with language disorders do not have major mental health problems. We have a huge focus on mental health at the moment, and that’s right, but most children are resilient and are doing just fine. What we want to do is raise awareness that those with DLD are at a higher risk, and help teachers to develop their language, and use language to foster resilience and mental wellbeing.
