CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children
PLoS One
Bishop, D. V., Snowling, M. J., et al. (2016).
PLoS One, 11(7), e0158753.
<p>This consensus guideline provides statements on the criteria used to identify and classify language impairment in children. This document is the first part of a two-part guideline; see the Associated Article below for the second part.</p>
CATALISE Consortium
A correction has been issued for this article:<ul><li>The PLoS One Staff. (2016). Correction: CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children. <i>PLoS One, 11</i>(12), e0168066. doi:10.1371/journal.pone.0168066</li></ul>
It is recommended to reassess for language problems after six months. Although current research indicates that it is difficult to predict longer-term language problems in late talkers (children aged 18-24 months with limited expressive vocabulary), many late talkers catch up without any special help. Children at greatest risk of persisting problems are as follows:
<ul>
<li>late-talkers with poor language comprehension;</li>
<li>poor use of gesture; and/or </li>
<li>a family history of language impairment.</li>
</ul>
For children between 4 and 5 years of age, any of the following features may indicate atypical language, speech, or communication development:
<ul>
<li>at most three-word utterances;</li>
<li>inconsistent or abnormal interaction;</li>
<li>poor understanding of spoken language;</li>
<li>unfamiliar listeners (e.g., strangers) cannot understand much of the child’s speech; and/or</li>
<li>familiar listeners (e.g., close relatives) cannot understand more than half of the child’s speech.</li>
</ul>
A staged approach to language assessment should be used with standardized tests. To indicate the nature and severity of the impairment, an initial age-appropriate assessment tool should be used to assess a range of receptive and expressive skills. Then, conduct more specific assessment as necessary.
"Reasons for referral for specialist assessment/intervention include concern about speech, language or communication expressed by caregivers (which includes parents and guardians), teachers or healthcare professionals, or a lack of progress in language or scholastic attainment despite targeted classroom assistance" (p. 9).
"Aspects of language impairment that are relatively uninfluenced by social and cultural background are nonword repetition, sentence repetition, and production of grammatical inflections marking verb tense" (p. 13).
"Some children [with moderate-severe-profound hearing loss] have language abilities—in spoken and/or signed language—that are well below those of [other children with hearing loss] ..., and may be regarded as having a disproportionate language impairment that is not secondary to hearing loss" (p. 16). As children with hearing loss can have a language impairment affecting the acquisition of sign language or spoken language, "language assessment and intervention [for children with hearing loss] ... requires specialist skills" (p. 16).
<p>"Training of speech and language therapists/pathologists should encompass assessment and planning of intervention for children who have pragmatic difficulties (including those diagnosed with DSM-5 social communication disorder)" (p. 13). Psychologists and educators may also have a beneficial role in identifying and planning for the needs of children with language impairment.</p>
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<p>"Speech and language therapists/pathologists have specialist expertise in the assessment of problems with production of speech sounds, many of which are linguistic rather than motor/structural in origin" (p. 14).</p>
For children between 1 and 2 years of age, any of the following characteristics may indicate atypical speech, language, or communication, and should be referred to the appropriate professionals (i.e., speech-language pathologists, developmental specialists) to assess for hearing loss, autism, or intellectual disability:
<ul>
<li>no babbling; </li>
<li>no response to speech and/or sounds; and/or</li>
<li>minimal/no attempts to communicate.</li>
</ul>
<div>For children with English as an Additional Language, a language problem would be evident in the home language(s); however, direct assessment of the home language(s) may not be feasible. Report from family member (e.g., interview, checklist) may clarify if the child’s skills in the home language are of concern. Dynamic assessment is also a promising approach in children with English as an Additional Language.</div>
"Language impairment should be identified regardless of whether there is a mismatch with nonverbal ability. Where a child has a language impairment in the context of markedly poor nonverbal functioning and/or significant limitations of adaptive behaviour, the primary diagnosis should be intellectual disability, with a secondary diagnosis of language impairment" (p. 15).
<p>"Multiple sources of information should be combined in assessment, including interview/questionnaires with parents or caregivers, direct observation of the child, and standardized age-normed tests or criterion-based assessments" (p. 11).</p>
<p>"A low score on a language test should be interpreted in relation to information from observation and interview; functional impact as well as test performance needs to be taken into account when identifying the child's needs" (p. 11).</p>
<p>"There is no clear cut-off that distinguishes between language impairment (regardless of its cause) from the lower end of normal variation of language ability" (p. 11).</p>
"Language impairments may go undetected. Referral for language assessment is recommended for children who present with behavioural or psychiatric difficulties, and for children with poor reading comprehension or listening difficulties" (p. 9).
For children between 2 and 3 years of age, any of the following features may indicate an atypical development in speech, language, or communication:
<ul>
<li>minimal interaction; </li>
<li>does not display intention to communicate; </li>
<li>no words; </li>
<li>minimal reaction to spoken language; and/or</li>
<li>regression or stalling of language development.</li>
</ul>
<p>Children on the autism spectrum need intervention approaches that address social, behavioral, and language difficulties. Many children on the autism spectrum may have difficulties with the structural aspects of language similar to children who are not on the autism spectrum.</p>
<p>"Children with known syndromes (e.g., Down syndrome, Klinefelter syndrome) often have accompanying language problems that resemble those seen in children with no known aetiology" (p. 15).</p>
For children between 3 and 4 years of age, any of the following features may indicate atypical speech, language, or communication development:
<ul>
<li>at most two-word utterances;</li>
<li>does not understand simple commands; and/or</li>
<li>close relatives cannot understand child’s speech.</li>
</ul>
For children 5 years old or older, the following characteristics may be indicators of atypical language, speech, or communication development:
<ul>
<li>difficulty telling or re-telling a coherent story;</li>
<li>difficulty understanding what is read or listened to;</li>
<li>difficulty following or remembering spoken instructions;</li>
<li>poor engagement in reciprocal conversation; and/or</li>
<li>many instances of over-literal interpretation.</li>
</ul>
