What should I write in my report?

by Lisa Archibald

DLD Diagnostics Flowcharts

Let’s begin with a fairly simple scenario: You are a speech-language pathologist / therapist (SLP/T), you’ve completed an assessment of a child, and you’ve determined that the child has a Developmental Language Disorder (DLD).

One question I’m often asked is about what wording to use in a report when diagnosing DLD. Of course, there are probably as many different ways to word this kind of finding as there are SLP/Ts in the world! Reports are individualized to particular children’s profiles, service settings, and care teams. There’s no one ‘one size fits all’ for SLP/T reports, nor should there be! Nevertheless, it’s often helpful to build on a solid foundation, and it is in this spirit that I provide this entry and the attached flowchart (v. 1).

It might seem obvious, but one important consideration for inclusion in a report is naming the child’s condition as DLD. Parents and educators consult SLP/Ts in order to gain a better understanding of the child’s communication difficulties. They are looking for more than a (long) list of the child’s characteristics. They need a concise description that fits their child, and lets them begin the journey of seeking information, finding others with the similar experiences, and advocating for their child. Here’s when naming the child’s communication disorder comes in. The DLD label becomes a ‘verbal shorthand’ for representing the features of the disorder, and facilitates parent or educators' further research and conversations. I know that there are many other issues around labels that need to be considered, and perhaps we will take these up in future entries. For now, though, let’s keep focused on sharing a diagnosis of DLD.

It’s very important to realize that simply giving the DLD label is not enough. DLD is a broad label describing a heterogenous group of children with persistent language difficulties with a functional impact. Those persistent language difficulties, however, will look different from child to child. One child with DLD might have difficulties in phonology and syntax, and another with semantics and pragmatics. An SLP/T will use their expert clinical knowledge, skills and judgement to assess a child’s language skills. A number of areas will be considered including phonology, syntax, semantics, word finding, pragmatics/language use, and verbal learning & memory, as well as the presence of risk factors and other co-occurring disorders. The results will provide the necessary information for the SLP/T to describe a particular child’s DLD profile of strengths and weaknesses. There is no suggested or prescriptive wording here. The details to include, the areas to describe, the wording to use – these are all determined by clinical judgement.

One final consideration is the role the report has to play in providing information about DLD, and about its diagnostic process. I came to appreciate the possibilities here when a colleague on the RADLD.org international committee, Shaun Ziegenfusz (see also @shaunziegenfusz on twitter), provided suggestions for wording to include in a report. Statements that define and describe DLD, and that recognize the limits of diagnosis especially in the context of a single assessment seem to me to be very powerful. They will add understanding when a parent goes home to read and re-read an assessment. When the SLP/T is not present, those reassurances will remain. Such statements are well worth considering for inclusion, and I am indebted to Shaun for suggesting them. To this end, the flowchart refers to an attached DLD information sheet. I do not think a generic sheet will do here, and I haven’t made one. I imagine something specific to your region and service context, and drawing on the valuable resources available at RADLD.org, DLDandMe.org, and others. If you make one, please do send me a copy!