Neglect of Mental Health Needs Found Among Young People with Language Disorders

DLD is a lifelong condition that affects around 7.5% of children in the UK. It causes difficulties with talking and understanding what other people say – which can create barriers to communication.

Difficulties with speaking might manifest as delayed early language milestones, saying less overall, and use of simple sentences with reduced vocabulary. Problems with understanding may look like not paying attention or not following instructions because the child can’t figure out or remember what they are being asked to do.

In a new Comment article for The Lancet Child and Adolescent Health, researchers highlight the mental health problems experienced by children and young people with the condition, and explain that children identified as having DLD are around twice as likely to experience poor mental health by adolescence compared with their peers.

Meanwhile, a very high proportion (between 40-66%) of young people referred to CAMHS have language difficulties.

The team, led by Professor Courtenay Norbury (UCL Psychology & Language Sciences), said: “Many young people with DLD experience increasing anxiety as they approach adolescence, due to the increasing language demands of the school curriculum and peer relationships.

“They describe the constant struggle associated with trying to keep up with lessons and conversation, often try to mask their difficulties by nodding and agreeing even when they don’t understand, or withdraw from social situations in which they might be exposed, including school.”

There is a need for a more joined up approach to care.

The researchers argue that speech-language therapists are unable to address the mental health needs of their clients, due to professional boundaries. Meanwhile, many clinical psychologists feel ill-equipped to deal with the language needs of their patients.

As a result, the team have made several recommendations, including:

• Raising awareness of DLD among all health-care professionals so they can refer children who are not developing as expected for further evaluation by speech-language therapists.
• Language interventions that target language skills that specifically support social and emotional understanding.
• Language interventions that include support and guidance for conversation partners and significant others.
• Adaptations to existing mental health interventions, such as cognitive behavioural therapy, to make them more accessible to young people with DLD.

Professor Norbury writes: “There is an urgent need to address inequality in access to health services, especially mental health provision for young people with DLD.

“To overcome this gap, we must increase awareness of DLD, develop and test novel interventions, and amplify the voices of affected young people through international interventions.”

Royal College of Speech and Language Therapists’ Head of Research and Outcomes Amit Kulkarni said: “Given the prevalence of Developmental Language Disorder (DLD) and its potential impact on mental health, I’m delighted to see this important research. It highlights the scale and impact of DLD, prompts reflection on traditional talking therapies, and provides practical suggestions for improving multi-disciplinary working to ensure children and young people can access the best support possible.”

Patient story

Charlie, 11, from West Yorkshire, was diagnosed with DLD in September 2023. His parents noticed delays in his emotional development from the age of five. However, a lack of awareness meant that he struggled to get the help that he needed, and his mental health was dramatically impacted.

Charlie’s mum, Kat Murphy, 42, says: “From about the age of five, we noticed that Charlie wasn’t progressing with his emotional development. He still had lots of meltdowns, an inability to share and language difficulties.

“I brought up my concerns with his health visitor and we received a visit from our local community healthcare provider, who gave us parenting tips and coping strategies – as they believed that the way Charlie was acting was a choice.

“As he progressed through nursery and school, more and more academic struggles showed. He was always classed as low ability and struggled massively to concentrate. He was in various interventions including for handwriting, maths and phonics.

“By Year 2, he started to express his dislike for school. He had meltdowns and would scream and shout that he hated it and didn’t want to go. I brought this up with his teachers but, frustratingly, because he masks his behaviour at school, I was told that everything was fine.

“Eventually Charlie was referred for a neuro-developmental assessment with CAMHS but the only help we received was a paragraph sign-posting information.

“It felt like we were in limbo. Our son was growing up with age but not developmentally – and the gap was getting bigger between him and his peers. The pandemic only made things worse – myself and Charlie’s dad were both key workers, so Charlie had to go to school daily. The teachers changed weekly, the children changed daily and Charlie was having more and more meltdowns. Sometimes he would cry uncontrollably in the car on the way home.

“Charlie was sad and angry most of the time – sometimes he couldn’t get up and when he got upset he would shout things like ‘I hate my brain’. A nine-year-old should never feel so defeated about life.

“But we just kept being dismissed. Charlie tries so hard, but he is often met with teachers who accuse him of being lazy or not trying hard enough.

“At home we have learnt that simple, short commands and visual aids work best for him. For example, we always buy the same shampoo and conditioner so he can remember which order to wash. Charlie loves routine and feeling safe.

“Last year, we finally saw the child and adolescent speech and language therapy (SALT) services, who diagnosed Charlie with DLD. I had never heard of it before, and it broke my heart to find out how hard he found it to follow instructions and understand what we said to him.

“His whole life, people have fobbed us off and now Charlie has been left with no self-worth and no self-confidence.

“We need to ensure that healthcare professionals and teachers are aware of DLD, so they can provide the appropriate support and early interventions to ensure that children like Charlie get the help that they need.”