Primary language disorder: 1 in 4 “late talkers” develops it

Let summer be an opportunity for observation and attention by parents. In Italy, in fact, 15% of children are late talkers, who at 2-3 years of age speak little or nothing. An army of about 400 thousand children who, in 25% of cases - one in four - develop a Primary Language Disorder (PLD), also known as Developmental Language Disorder (DLD), but still too often confused with other difficulties or identified late, when the consequences are already evident. If not diagnosed promptly, PLD - which affects about one in 14 children, or 7% of those of preschool age - can have a negative impact on childhood and adolescence, influencing school performance and social relationships, and also in adulthood, increasing the risk of depression and anxiety. Even if the numbers have been stable over the last ten years, this is a large segment of the child population that requires early attention, because intercepting critical signals before the age of 3 can mean avoiding a worsening of the clinical picture.

This was discussed at the conference “Evidence Based Medicine in neurodevelopment: a focus on Primary Language Impairment”, which was held in Padua. The event is organized by the GE Ghirardi ETS Foundation in collaboration with CLASTA ((Communication & Language Acquisition Studies in Typical & Atypical populations), FLI and LabAcademy in Villa Contarini, in Piazzola sul Brenta (Padua), and renews the path started in 2018 with the first Consensus Conference on DPL, drawn up with the support of the National Guidelines System and the Istituto Superiore di Sanità.

“Seven years after the first Consensus Conference on Primary Language Impairment, it is time to take a step forward – explains Maria Chiara Levorato, CLASTA representative, organizer of the conference and former full professor at the Faculty of Psychology of the University of Padua. Today we have more solid knowledge, but we need to make access to diagnostic tools homogeneous and strengthen networking between pediatricians, educators, clinicians and families. Our goal is to improve early identification of the disorder and timely care, to reduce inequalities and consequences, often very serious in adolescence and adulthood”. Screening: the 50 words to pronounce The disorder can be diagnosed as early as 4 years of age, but predictive indicators emerge much earlier.

From 0 to 3 years

“In the 0-3 age group there are fundamental developmental stages – underlines Tiziana Rossetto , president of the Italian Speech Therapists Federation –. For this reason, the theme of early screening within 36 months will be central, together with the use of enhancement tools in nursery school and the involvement of parents. In Italy we have validated tools such as the Primo vocabolario del bambino, which allows for a simple but effective assessment of linguistic skills”. The picture also closely concerns the so-called “late talkers”: children who speak little or later than their peers, but do not always develop a disorder.

50 words at two years old

“At two years old, a child should produce at least 50 words in the language to which he has been exposed since birth. And at 2 and a half years old, he should combine at least two words to form his first sentences,” explains Alessandra Sansavini , full professor of Developmental Psychology at the University of Bologna. “The gesture of pointing is also important: it serves to share attention with the adult on what the child is interested in and wants to communicate. If it is absent at 12 months or still poorly produced at 18 months, it is an indicator to consider. These predictive indicators are shared in the literature and must be identified early by pediatricians with the collaboration of parents, educators and teachers, and assessed by a multi-professional team, made up of a neuropsychiatrist, speech therapist and psychologist, through an assessment and monitoring process, also activating processes to promote communicative exchanges between parents and children and encourage language development.”

Effects on mental health

The complexity of DPL also concerns comorbidity with other neurodevelopmental disorders. “Primary Language Impairment is often associated with other conditions such as ADHD, motor coordination disorders or learning disorders,” explains Elisa Granocchio , a child neuropsychiatrist at the Carlo Besta Neurological Institute in Milan. “In adolescence or adulthood, children with untreated DPL may therefore develop anxiety, depression and social difficulties.” The diagnosis remains complex, also due to the lack of harmonization between international clinical classifications and Italian practice. “However,” adds Prof. Granocchio, “genetics is offering new interpretative keys, studying alterations of the sex chromosomes, genomic imbalances or gene variants that are at the basis of some clinical phenotypes, opening up prospects for the development of targeted therapies, as already occurs in other areas of neurodevelopment.”

The risk is that these kids remain invisible precisely at the most critical moment of growth. “DPL does not disappear with growth, but takes on less recognizable forms – observes Anna Giulia De Cagno , speech therapist and vice president of FLI –. Recent studies show that over 15% of adolescents have significant communication-linguistic difficulties, with a ratio of 2:1 between males and females. The difficulties concern the comprehension of school texts, written production, metaphorical language and social relationships. More than 60% of kids with DPL report episodes of bullying. It is essential that high schools also be made aware, to prevent these kids from being left without a diagnosis or support”.

The event is also an opportunity to relaunch and update the National Consensus Conference. “This is with a view to improving identification, care and quality of care throughout the country,” explains Maya Roch , associate professor at the Department of Developmental and Social Psychology at the University of Padua. “We have valid tools, shared scales and guidelines at our disposal: now we need a structured and uniform national strategy,” concludes the FLI president. “It’s time to act.”