Language Learning Impairment – the poor relation to dyslexia and autism?

Bishop 2015 Does a child’s diagnosis depend on professional seen?

Overlap of specific learning difficulties


After seeing this

Tweet which triggered this post.

 I glibly stated that I wanted to blog on Language Learning Impairment (LLI)/Specific Learning Impairment (SLI).

Do you know what it is? Perhaps you’ve heard of Specific Learning Difficulties (SpLD)? If you have you may think it’s dyslexia, dyspraxia, ADHD, ADD, dyscalculia or Autistic Spectrum Condition/Disorder ASC/D (used to be called Asperger’s or high functioning autism but now changed due to DSM-5) but not LLI. 

I’ll prompt you again, Speech and Language Therapy (SALT). Oh right yes, now I know what you mean. It’s speech problems, articulation? Or don’t SALT work with ASD and social communication? I think I may even have heard Complex Communication Difficulties used recently – what’s that? 

So, is LLI a communication difficulty?  
You can see the problem here…so many labels, many overlapping because it is the exception rather than the rule for difficulties to be pure – comorbidity is far more common; ASD with dyspraxia for instance or ADHD with dyslexia. Even the decision on diagnosis could be linked to which professional a student sees as shown in Professor Bishop’s slides above.

In the new SEN Code of Practice communication difficulties are described as Speech, Communication and Language Needs – SCLN – this is a catch all phrase and can mean various forms of difficulties in communication. 
Alternatively, it may be that a professional decides what the student’s primary need is, language disorder or autism? The really complex children are often a severe mix; so my students with speech and language difficulties will often struggle more if this co-occurs with ASD or dyslexia.

 It is also further complicated as language is the precursor to literacy. As an example I had two year 11 students whose language scores suddenly improved – it appears now they are soaking up phonics and their reading is improving rapidly. In the transition notes to college I have been very clear that they will need phonic based dyslexia support.

If you listen to SENDCos and specialists in schools across the country I’m pretty sure you’d hear the ‘ey’ diagnoses; ‘he’s a bit languagey’ or ‘she’s spectrumey ‘ – horrifying for psychologists  I’m sure!

Trends also show how certain labels fall out of use:  Asperger’s for instance and dysphasia are no longer officially used whereas verbal dyspraxia, attachment theory, sensory overload and auditory processing disorder are terms which seem to be common at present.

Returning to the above tweet however, LLI is one of the most common learning difficulties in mainstream schools yet possibly the least understood by teachers in both primary and secondary. It’s also had the least research which equates to less money spent on it. Language Learning  Impairment is the true hidden disability. 

SLI was until recently the preferred term but concerns that it suggested too narrow a group of children led to LLI which encompasses any child with language impairment regardless of underlying ability.

A crude comparison could be with dyslexia; whereas this signifies a set of behaviours linked to struggling with reading, writing and spelling, LLI behaviours are with talking and understanding language. These are expressive and receptive language difficulties. It is also possible to have strength in one and weakness in the other. 

LLI is at least as common as dyslexia and more common than autism. It’s expected that there is one student with LLI in every classroom (Bishop 2014).

A typical student in mainstream with LLI may have basic functional literacy (although not always) so does not get picked up by screening tests. Once a comprehension test is given, it may become more apparent but as these students often appear ‘typical’ and read and write OK, it’s not until you begin chatting to them individually that you start to see where the difficulty lies. They may even have hidden that quite well coming across as quiet or a bit rude, dismissive even and monosyllabic. Or perhaps, they’re quite chatty but don’t make much sense; I often say to teachers that these students may talk round a subject, never quite getting to the point. A good indicator is to ask yourself, what have they actually just said to me? If you struggle to work it out then there may be some language difficulties. Other students with LLI are often described as not listening, staring out the window, blank, in their own world. He or she might be incredibly frustrating as they never do what you ask, they clearly weren’t paying attention as what they’ve written has absolutely nothing to do with the task you set. Worse still they haven’t written anything.

The student may get into trouble in group situations, outside at break time or in class. They look guilty, they couldn’t explain what had happened whereas the other student was able to fluently describe the incident, the child with LLI just shrugged and walked off or was somehow appearing cagey so thought to be guilty.  

These are typical students with LLI. It is no surprise to learn that statistically, a student with language difficulties is more likely to end up in prison – perhaps they struggle to get out of tricky situations or may not have realised what they were being asked to do – everyone else has reacted quickly and run off. In the court room under cross examination, they become confused – it’s going so fast, so much language being fired at them – just as they’ve processed a question it seems another is asked, confusing them further. They appear truculent, aggressive yet are more likely to be frustrated and unable to react quickly. 

I’ve painted a depressing picture here haven’t I? It doesn’t need to be like this however, similar to dyslexia, although residual difficulties will remain in adulthood, the language deficit can be remediated through specialist support, by teaching language and offering strategies. By making reasonable adjustments in the classroom these students can thrive in a mainstream school.

Here are some tips

Time, time and more time – schools go so fast – but allowing the sudent with LLI just a little more time to answer a question of complete a task will make a lot of difference.

Visual visual visual – no, I’m not saying they’re a visual learner but when language is a barrier, using visual prompts can help to signpost activities for a student with LLI and trigger memory. By using images of the subject you’re discussing, it will help the student to link the information and categorise for storing. 

Modify language – for many students it is good to challenge them with extended vocabulary but for the student with LLI, it is the carrier language and phrasing which can confuse them. Try to concentrate on the knowledge you want them to learn and simplify the other bits of language. 
 Keep your sentences short and concise. Use simple language with the key words they need to learn.

Students with LLI may also need literal language, struggling to cope with metaphor and idioms. 

Break down instructions into small steps – you can get your TA to break tasks down with a tick box after each one. Chunk instructions and information.

Knowing that just because they’ve nodded at you does not necessarily mean they’ve understood is a vital skill for the teacher of a student with LLI. Asking them to repeat back what they have they to do is a useful strategy (but allow them time to do this).
Being sympathetic to language overload and spending 5 minutes with them explaining with some spot images (like bullet points but small pictures) can make a difference. 
Asking the student to repeat back what they have to do will help them.

Further reading 
Professor Dorothy Bishop researches and champions LLI. She is part of RALLI – raising awareness of language impairments (RALLIcam). There are many excellent YouTube clips. 

http://www.youtube.com/RALLIcampaign
Professor Bishop is also good to follow on Twitter @deevybee and her blog is one of the best out there. http://deevybee.blogspot.com/

Professor Pamela Snow (@PamelaSnow2) has influenced me and knows much about literacy and language (and phonics). Her blog, The Snow Report is here: http://t.co/sP2ewQ80YB. I think she has persuaded me to change my mind on a number of occasions too.
Susan Ebbel, a speech therapist, has created shape coding – it’s a visual strategy for grammar using shape and colour.
Stephen Parsons (@WordAware) has been a useful contact and has a great book. http://www.thinkingtalking.co.uk/

I Can Charity has many resources and knowledge on LLI (@iCANcharity).
@afasic is also an excellent source of information as is Communication Trust (@comm_ntrust).

NAPLIC is the association for language impairment in children.

There’s hashtags #LLI_ #SLpeeps and @WeSpeeches is a collective Twitter account for speech and language professionals. They often have useful chats on Twitter. Caroline Bowman as @speech_woman is another account to follow. 

M
Links

http://www.councilfordisabledchildren.org.uk/media/547918/sli_handbook_early_support-040413.pdf

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