Language and communication disorders — DLD, SPCD and SLT-first care (MEQ)

(i) Differential map and primary formulation (4 marks)

Separate speech (fluency: possible stuttering with sound/syllable repetitions), language (receptive/expressive delay — short sentences, needs visual demonstration, classroom non-following), and social communication (secondary frustration vs primary SPCD). No RRBs — ASD less likely; do not force SPCD without pragmatic-primary profile and ASD exclusion.[1][6]

Most likely: developmental language disorder / language disorder (CATALISE DLD if no explaining biomedical condition after assessment) with possible childhood-onset fluency disorder features and secondary behavioural dysregulation; ADHD remains a comorbidity hypothesis after language is mapped, not a default sole diagnosis.[2][3]

(ii) Assessment priorities (4 marks)

• Multi-informant developmental history (first words, combinations, regression, family literacy/language history, both languages).[1]
• Audiology (never tested — mandatory).[1]
• Direct language sample + comprehension checks; school work samples.
• Speech-language pathology standardised assessment; fluency rating if stuttering suspected.[4][5]
• Screen ADHD, ASD, anxiety, literacy; cognitive profile if ID suspected.
• No routine MRI/EEG without red flags (regression, seizures, progressive signs).[1]

(iii) Management plan (5 marks)

• First-line: SLT for language and speech — Law meta-analysis supports benefits especially for phonological/expressive vocabulary targets; receptive needs sustained contextual intervention.[4]
• School: simplified multi-step instructions, visual supports, extra processing time, literacy support (oral language underpins reading comprehension).[8]
• Parent strategies: expand language input, reduce punitive responses to "non-compliance" that is comprehension failure.
• Fluency: if preschool/early stuttering significant, discuss Lidcombe Programme with SLP — Jones 2005 RCT efficacy.[5]
• No medication for core language disorder; consider ADHD pathway only if impairing ADHD remains after language-accessible assessment.[4][7]

(iv) Behaviour and language evidence (3 marks)

Yew and O'Kearney meta-analyses show elevated later internalising and externalising difficulties in children with specific language impairments — behaviour often secondary to communication failure, peer stress and academic frustration rather than pure "oppositionality."[7]

(v) Bilingualism and ASD/SPCD (4 marks)

Bilingualism does not cause DLD; assess across languages and support dual-language home use.[1][2] SPCD requires persistent pragmatic deficits and cannot be diagnosed when full ASD criteria are met; here absence of RRBs and clear structural language deficits point away from SPCD-as-primary and away from ASD without further red flags — still document social reciprocity carefully.[6]

Marking notes. High-scoring answers map levels of communication, name CATALISE/DLD, demand audiology and SLP, cite Law and Lidcombe, link Yew behavioural risk, and avoid bilingual-blaming and automatic SPCD/ASD errors.[2][3][4][5][7]