1. How is specific language
impairment identified?
Dorothy V M Bishop

2. Specific language impairment (SLI)
• Identified in children when language
development falls well behind that of other
children of the same age
• Problems interfere with everyday life and
school achievement
• Not due to hearing loss, physical abnormality,
acquired brain damage, lack of language
experience
• Not part of a general developmental delay

3. The first step
• Child comes to attention because a parent,
caregiver or teacher recognises a problem,
such as:
• Doesn’t talk much
• Language seems immature for age
• Struggles to find words
• Doesn’t seem to understand what is said
• In older children, may fail to understand written
language

4. N.B. Be aware that…
• Language problems are not always obvious.
• Language difficulties may underlie problem behaviour
such as:
• Anxiety in social situations
• Bad behaviour in class
• Inattention
• Failure to obey instructions
• Problems with peer group
• Academic problems (esp. poor reading/writing)
Cohen, N. J. (1996). Unsuspected language impairments in psychiatrically disturbed
children: developmental issues and associated conditions. In J. H. Beitchman, N. J.
Cohen, M. M. Konstantareas & R. Tannock (Eds.), Language, Learning, and Behavior
Disorders (pp. 105-127). Cambridge: Cambridge University Press.

5. Three strands to assessment
• Information from
parents/caregivers/teachers
• Direct observation of the child in a natural
setting
• Formal assessment using standardized
tests

6. Information from parents and
others who know the child
• May be seen initially by paediatrician, speech and language
therapist, or educational psychologist, who will take a case
history
• Useful if parent or teacher can give specific examples of how
the child communicates and can describe occasions when
child’s language problems have been an issue
• Need to know what motivates the child to communicate and
how communication is achieved – e.g. does the child use
gesture/pointing
• Can he/she follow simple verbal instructions out of context?
• Can he/she understand a story, or talk about something in the
past in a coherent sequence?
Bishop, D., & Norbury, C. F. (2008). Speech and language disorders. In M. Rutter, D.
Bishop, D. Pine, S. Scott, J. Stevenson, E. Taylor & A. Thapar (Eds.), Rutter's Child and
Adolescent Psychiatry (pp. 782-801). Oxford: Blackwell.

7. Standardized approaches to
parental report
• Parental report may be obtained by a standardized
interview such as the Vineland Adaptive Behaviour
Scales (which also assesses other domains)
• The Children’s Communication Checklist-2 is useful
for screening for language problems and can be used
to pinpoint particular types of difficulty
Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior
Scales: Second Edition (Vineland II), Survey Interview Form/Caregiver Rating Form.
Livonia, MN: Pearson Assessments.
Bishop, D. V. M. (2003). The Children's Communication Checklist, version 2 (CCC-2).
London: Pearson.

8. Direct observation of the child
• Clinician may observe how the child communicates
with a parent
• For those at school, it can be informative to observe
the child interacting with other children in the
classroom
• The focus will be on the language used by the child,
the extent to which the child appears to understand
what others say, and whether the child uses nonverbal
means of communication, such as gesture and facial
expression

9. Standardized assessments
• A standardized assessment is one that has been
given to a large group of children of different ages, to
establish the normal range of performance.
• Test scores are often reported as percentiles, which
indicate the percentage of people obtaining a score at
a given level or below.
– A score at the 50th percentile is average for age – half the
population would be expected to get a score lower than that
– A score at the 10th percentile would mean one in 10 children
would get a score this low (or lower)
– Common cutoffs for disorder: either 16th percentile or 10th
percentile

10. Test scores and language impairment
– Scores are not set in stone: a child’s performance
may vary depending on how they feel on the day
– In general, language impairment would not be
identified on the basis of a single language test
– It’s more usual to give a collection of assessments
that look at different aspects of language, and then
to consider the overall profile
– One way of combining information devised by
Tomblin and colleagues: EpiSLI (see next slide)

11. EpiSLI criteria
EXPRESSIVE RECEPTIVE
Vocabulary Vocabulary Vocabulary composite
Grammar Grammar Grammar composite
Narrative Narrative Narrative composite
Expressive composite Receptive composite
Total of 6 tests, giving 5 composites
Language impairment: 10th percentile or lower on 2+ language composites
Tomblin, J. B., Records, N. L., Buckwalter, P., Zhang, X., Smith, E., & O'Brien, M. (1997).
Prevalence of specific language impairment in kindergarten children. Journal of Speech
and Hearing Research, 40(6), 1245-1260.

12. Limitations of test scores
– Test scores have advantage of being reasonably
objective; standardized tests have strict instructions
on administration and scoring
– But some aspects of communication not easy to
capture on tests
– Also, should we worry about a child who gets low
test score if neither teachers or parents are
concerned?
– In Tomblin et al study, only 29% of children meeting
EpiSLI criteria were enrolled in intervention

13. Combining test scores and parental
report
– Parental checklist, CCC-2, identifies different subset
of children than standardized tests
– Children identified by parental checklist do often
have academic problems, so seems parental report
is capturing important information that may not be
picked up by tests
– May be best to combine both sources of
information: standardized tests and parental report
Bishop, D. V. M., & McDonald, D. (2009). Identifying language impairment in children:
combining language test scores with parental report. International Journal of Language
and Communication Disorders, 44, 600-615.

14. Assessing nonverbal abilities
– Children with SLI often have additional problems,
especially with attentional skills and motor skills
– However, they are usually distinguished from
children who have a generalised cognitive
impairment by the fact that they have normal range
nonverbal ability
– Assessment of nonverbal ability is done using a
standardized test that looks at ability to reason
using nonverbal material, e.g. shapes and pictures.

15. Debate over nonverbal ability
– Some formal definitions of specific language impairment,
such as the one in the International Classification of
Diseases – 10, require that a child has a substantial gap (1
SD or more) between their nonverbal ability and language
ability
– This has been criticised on several counts:
• Very few children meet that criterion
• A child’s response to treatment doesn’t depend on whether they have
a big or small gap between language and nonverbal ability
• Twin studies do not support the idea of a language-nonverbal gap as
defining a coherent group with a common genetic basis
Bishop, D. V. M. (2004). Specific language impairment: diagnostic dilemmas. In L.
Verhoeven & H. Van Balkom (Eds.), Classification of Developmental Language
Disorders (pp. 309-326). Mahwah, NJ.: Erlbaum.

16. EpiSLI criteria (Tomblin et al)
• SLI definition requires normal range nonverbal ability, but does
not require large gap with language. Also studied children with
Nonspecific LI, with low language/nonverbal scores
• Specific language impairment (SLI):
– score at/below 10th percentile or lower on two or more language
composites
– 19th percentile or above on nonverbal IQ
• Non-specific language impairment (NLI):
– score at/below 10th percentile or lower on two or more language
composites
– below 19th percentile on nonverbal IQ
These two groups vary in severity, and the SLI group has better outcome.
But overall, differences are a matter of degree; few qualitative differences

17. Terminology
Speech, language and
communication needs
SLI =
Developmental dysphasia =
Specific developmental
language disorder =
Primary language
impairment