Speech sound disorder or DLD (phonology)? : towards a consensus agreement on terminology.

Stringer, Helen and Cleland, Joanne and Wren, Yvonne and Rees, Rachel and Williams, Pam (2023) Speech sound disorder or DLD (phonology)? : towards a consensus agreement on terminology. International Journal of Language and Communication Disorders. ISSN 1368-2822 (https://doi.org/10.1111/1460-6984.12989)

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Background The publication of phase 2 of the CATALISE project in 2017 clarified terminology for children with developmental language disorder (DLD) or delay but unintentionally muddied the water for children with unintelligible speech. A diagnostic label of DLD (phonology) indicates poor prognosis and phonological disorder that persists into middle childhood. However, in contrast to other diagnostic labels that fall under the overarching term of speech sound disorder (SSD), DLD (phonology) does not elucidate the characteristics of the child’s speech nor does it point us in the direction of appropriate intervention. Aims The aim of this paper is to discuss terminology in SSD leading to an evidence based model which builds on the model of DLD developed in CATALISE, supports descriptive diagnosis and signposts intervention. Methods Following a focused review of literature proposing or describing terminology for SSD, an expert group of researchers in developmental SSD proposed a revised model of existing terminology. Groups of UK speech and language therapists (SLTs) who provide services for children with SSD were asked to comment on its acceptability and feasibility. Discussion A three level terminology model was developed. This comprised an overarching Level 1 term; Level 2 terms that differentiated SSD of unknown origin from SSD with associated or underlying conditions; and specific diagnostic terms at Level 3 to support further assessment and intervention decisions. Consulted SLTs generally expressed agreement with the proposed terminology and a willingness to adopt it in practice. Conclusions Existing terminology for childhood SSD provides a good basis for clinical decision-making. A modified version of Dodd’s (2005) terminology was found to be acceptable to UK SLTs. There is an evident overlap of SSD with CATALISE terminology. However more detailed and specialist terminology than “DLD (phonology)” is required to support clinical decision-making. It is proposed that endorsement by the UK Royal College of Speech and Language Therapists (RCSLT) would obviate the need for a Delphi process.