👶 Normal Oral Language Development

To identify a disorder, one must first know the benchmarks of typical development. Language develops gradually according to relatively predictable stages, even though individual variability exists. Understanding these stages allows the speech therapist to accurately locate where the child is in their language development and to identify significant deviations.

Language development generally follows a predictable progression but with significant individual variations. Some children start speaking later than others without it being pathological. It is the combination of several factors that should raise concern: significant quantitative delay, particular qualitative difficulties, lack of progress despite a stimulating environment, and impact on functional communication.

The first months of life are marked by the development of precursors to communication: eye contact, joint attention, pointing, pre-verbal turn-taking. These skills are essential, and their absence should raise concern. Canonical babbling, which appears around 6-8 months, is a good indicator of future phonological development. The absence of babbling or poor babbling may be an early sign of difficulties to come.

📊 Classification of Oral Language Disorders

The terminology has evolved significantly in recent years with the adoption of new international classifications. It is important to master the current terms while also being aware of the old names still used by some professionals and in certain administrative documents.

The New International Nomenclature

The CATALISE consensus (2017) proposed a major revision of the terminology by replacing the term "dysphasia" with "Developmental Language Disorder" (DLD). This new name emphasizes the developmental nature of the disorder and avoids confusion with acquired disorders. It also aligns with a desire for international harmonization with the English term "Developmental Language Disorder" (DLD).

Simple Delay vs Specific Disorder

The distinction between language delay and developmental language disorder is clinically essential as it conditions the prognosis and the intensity of care. This differentiation is not always easy, especially in young children, and may require a period of observation with re-evaluations.

• Language Delay: Quantitative gap, homogeneous profile, expected catch-up, quick response to intervention, good long-term prognosis
• DLD: Qualitative impairment, heterogeneous profile, persistence despite appropriate intervention, major functional impact, risk of repercussions on learning

🧠 Developmental Language Disorder (DLD)

DLD, formerly known as dysphasia, is a neurodevelopmental disorder affecting the acquisition and development of oral language. It affects about 7% of preschool children, making it one of the most common childhood disorders. Despite its prevalence, it often remains underdiagnosed or diagnosed late.

Diagnostic Criteria According to the CATALISE Consensus

DLD is characterized by a great heterogeneity of profiles. Some children present predominant difficulties on the expressive side (phonology, lexicon, syntax), others on the receptive side (comprehension), and many present a mixed impairment. Manifestations also vary according to age, with an evolution of symptoms during development.

Language Components Affected

DLD can affect different components of language, either in isolation or in combination:

• Phonology: Organization of the sounds of the language, persistent phonological simplifications beyond the expected age, difficulties in phonological programming
• Lexicon: Reduced vocabulary stock, difficulties accessing words (word-finding difficulties), slow learning of new words
• Morphosyntax: Sentence construction, grammatical agreements, conjugation, omission of grammatical words
• Pragmatics: Use of language in social context, conversational skills, adaptation to context
• Discourse: Organization of narrative, narrative coherence, maintaining the theme

🔍 Speech Therapy Assessment of Oral Language

The oral language assessment is a fundamental act that requires methodological rigor and clinical finesse. It must allow for precise characterization of the disorder and guide the management. The evaluation is not limited to administering tests: it includes clinical observation, analysis of spontaneous language, and gathering information from the child's environment.

Areas to Systematically Evaluate

The anamnesis is a crucial step in the assessment. It allows for gathering information about the child's development, family history, linguistic environment, parental concerns, and the impact of difficulties in daily life. These contextual elements are essential for interpreting test results and formulating a relevant diagnosis.

Main Assessment Tools

• Complete Batteries: EVALO, ELO, N-EEL, EXALANG - allow for a global assessment of different components
• Specific Tests: ECOSSE (syntactic comprehension), TVAP (vocabulary), phonological tests
• Clinical Observation: Spontaneous language, play, interaction, communication pragmatics
• Parental Questionnaires: IFDC, developmental questionnaires - complement direct assessment

🎯 Principles of Oral Language Rehabilitation

Oral language rehabilitation is based on fundamental principles derived from research in speech therapy and language sciences. The effectiveness of the intervention depends on the quality of the initial assessment, the relevance of the set objectives, and the continuous adaptation to the child's progress.

Fundamentals of Effective Intervention

Research shows that the most effective interventions are those that explicitly target identified difficulties, with sufficient intensity and appropriate duration. "One size fits all" approaches are less effective than individualized interventions based on each child's specific profile.

Priority Work Areas

• Phonology: Auditory discrimination, phonological awareness, production of phonemes, intelligibility
• Lexicon: Vocabulary enrichment, semantic categorization, lexical access, definition
• Morphosyntax: Syntactic structures, verbal and nominal inflections, grammatical words
• Pragmatics: Turn-taking, adaptation to context, social communication skills
• Discourse: Narrative, temporal and causal organization, coherence and cohesion

"Oral language rehabilitation must be intensive, early, and multimodal. The earlier and more adapted the intervention, the better the long-term prognosis. Collaboration with the family and school is essential to generalize skills."

— International Recommendations on DLD (CATALISE)

📚 Evidence-Based Therapeutic Approaches

Several therapeutic approaches have demonstrated their effectiveness in rehabilitating oral language disorders. The speech therapist chooses and adapts their interventions according to each child's profile, objectives, and care context.

Main Families of Approaches

Current data suggest that explicit approaches are particularly effective for morphosyntactic work, while implicit approaches may be sufficient for certain lexical objectives. The combination of both approaches seems optimal for most children with DLD.

Specific Language Stimulation Techniques

• Modeling: The adult produces the correct model in a natural context without asking for repetition
• Expansion: Enriched reformulation of the child's utterance by adding missing elements
• Recast: Corrected reformulation of the erroneous utterance without explicit comment on the error
• Prompting: Gradual assistance (phonemic, semantic) to guide towards correct production
• Focused Stimulation: Massive and repeated exposure to a target form in a meaningful context

👨‍👩‍👧 Working with the Family

Family involvement is a key success factor in managing oral language disorders. Parents are the child's first interlocutors and can significantly enhance the effects of speech therapy rehabilitation. Parental guidance is an integral part of speech therapy intervention.

Areas of Parental Support

Practical Tips for Parents

• Speak slowly and clearly without exaggerating articulation artificially
• Get down to the child's level to encourage eye contact and attention
• Reformulate and enrich the child's utterances without directly correcting or requiring repetition
• Avoid making them repeat systematically, favor natural modeling
• Read stories daily and discuss the images and the story
• Value attempts at communication, not just perfect productions

🔔 Prevention and Early Detection

Early detection of language difficulties is essential for optimal intervention. The earlier the care, the better the prognosis. The speech therapist plays an important role in raising awareness among early childhood professionals and families about warning signs.

Warning Signs by Age

• At 12 months: No canonical babbling, no reaction to name, no communicative gestures (pointing, waving)
• At 18 months: Fewer than 10 words produced, no proto-declarative pointing, difficulties understanding simple instructions
• At 24 months: Fewer than 50 words, no word combinations, limited comprehension
• At 3 years: Unintelligible language to non-familiar listeners, no sentences, major comprehension difficulties
• At 4 years: Persistence of significant phonological simplifications, immature syntax, difficulties in storytelling