1) Specific language impairment (SLI) is identified when a child's language development falls significantly behind peers without an obvious medical cause like hearing loss, slow general development, brain damage, or physical abnormalities. 2) SLI often co-occurs with other neurodevelopmental disorders like dyslexia, ADHD, autism spectrum disorder, and developmental coordination disorder. 3) The boundaries between SLI and other conditions are unclear as the same child may receive different diagnoses depending on the assessing clinician, and underlying genetic factors may increase risks for multiple related impairments.

1. How specific is
Specific Language Impairment?
Dorothy V M Bishop

2. Specific language impairment (SLI)
• Identified when language development falls well
behind that of other children of the same age
• No obvious explanation. Typically exclude cases with:
– Permanent hearing loss
– Generally slow development in all areas
– Language problems after brain damage
– Medical syndromes
– Classic autism
– Physical abnormalities of mouth and tongue
– Problems just with second language learning

3. Other problems often occur with SLI
Dyslexia
SLI
Bishop, D. V. M., & Snowling, M. J. (2004). Developmental dyslexia and Specific
Language Impairment: Same or different? Psychological Bulletin, 130, 858-886.

4. Other problems often occur with SLI -2
SLI
ADHD
Tirosh, E., & Cohen, A. (1998). Language deficit with attention-deficit disorder: A
prevalent comorbidity. Journal of Child Neurology, 13, 493-497.

5. Other problems often occur with SLI -3
SLI
Hill, E. L. (2001). Non-specific nature of specific language impairment: a review of the
literature with regard to concomitant motor impairments. International Journal of
Developmental co-
ordination
disorder
(“dyspraxia”)

6. Other problems often occur with SLI - 4
SLI
Bishop, D. V. M., & Norbury, C. F. (2002). Exploring the borderlands of autistic disorder
and specific language impairment: A study using standardised diagnostic instruments.
Autistic spectrum
disorder
See also our slideshare
presentation on Autism
and SLI

7. Putting it all together!
Developmental co-
ordination
disorder
(“dyspraxia”)
Dyslexia
SLI
ADHD
Autistic spectrum
disorder
Bishop, D., & Rutter, M. (2008). Neurodevelopmental disorders: conceptual approaches.
In M. Rutter, D. Bishop, D. Pine, S. Scott, J. Stevenson, E. Taylor & A. Thapar (Eds.),
Rutter's Child and Adolescent Psychiatry (pp. 32-41). Oxford: Blackwell.

8. Boundaries between different
conditions are not clearcut

9. Dyck, M. J., et al. (2011). The validity of psychiatric diagnoses: The case of 'specific'
developmental disorders. Research in Developmental Disabilities, 32(6), 2704-2713.
608 children aged 3 – 14 years
 449 Typically-developing
 30 Autism spectrum disorder (ASD)
 24 Mental retardation (MR = UK learning disability)
 30 Receptive-expressive language disorder (SLI)
 22 Developmental co-ordination disorder (DCD)
 53 Attention deficit hyperactivity disorder (ADHD)
 Assessments of IQ, language, motor, attention,
social cognition, executive function
Western Australian study

10. Typical
Autism
MR
SLI
DCD
ADHD
Dyck et al: Differences between children
captured by two dimensions
Function 1
N.B.
No sharp boundaries
between disorders.
SLI overlap with other
conditions

11. A consequence of the overlaps:
Same child, different diagnosis
• Speech and language therapist: SLI
• Educational psychologist: Dyslexia
• Psychiatrist: Autism spectrum
disorder (ASD)
• Neurologist: Developmental
co-ordination disorder (DCD)
• Paediatrician: ADHD

12. Why are there overlaps between disorders?
• Technical term for co-occurrence is comorbidity
• One condition could increase the risk for the other:
e.g. Child with language problems may be inattentive if they
can’t understand instructions
• Another possibility: different conditions but with common
cause:
e.g. Genetic factors may affect development of brain
regions that are important for both motor and language
development
• Disentangling the possibilities is complicated! See
reference list for more information

13. For further reading
see reference list on:
http://www.slideshare.net/RALLICampaign/how-
specific-is-SLI