Developmental language disorder (DLD) is diagnosed when a young person’s language skills are persistently below the level expected for their age. DLD has significant effects on a child’s life that persist into adulthood.
DLD has a high prevalence amongst young offenders. In one study, 42% of the young people in a secure setting scored 1.5 standard deviations or more below the population mean in assessment of receptive language.
This study aimed to measure the prevalence of DLD in a cohort of first time offenders (Winstanley et al, 2020). By following them over 12 months, they addressed whether a DLD is associated with a higher rate of reoffending, independently from other known causes.
Participants were recruited from youth offending services in North West England. They tried to recruit consecutive young people referred to the service for a first offence.
Language ability was evaluated using two subtests of the CELF-4 assessment. The cut-off for DLD was >1.5 standard deviations below the normative mean. A sample of these scores was validated by an independent researcher.
The researchers also measured nonverbal IQ, adversity, prior offending, deprivation and callous-unemotional personality traits.
Participants were followed for 12 months, with the primary outcome being conviction for a subsequent offence.
145 young offenders took part.
- CELF-4 assessment showed that 87 (60%) had a developmental language disorder (DLD).
- 53 (62%) of the DLD participants reoffended compared with 14 (25%) of the non-DLD.
The Hazard Ratio for reoffending in DLD participants compared with non-DLD was 2.61 (95% CI 1.8 to 3.78).
People with developmental language disorder (DLD) were more than twice as likely to reoffend compared with those without.
- Replicating this study in different, larger and/or more complete cohorts
- Adapting interventions to take account of the high prevalence of DLD
- Involving speech and language therapists (SLTs) in multidisciplinary youth justice teams
- Running evaluation studies of these interventions.
Strengths and limitations
There are some inherent limitations due to the observational study design. Care was taken to investigate important confounding factors, specifically deprivation, adversity and nonverbal IQ. However, there may be other confounders we don’t know about at work. DLD may be acting as a marker and/or mediator of other factors.
There could also be selection bias in the sample. A large proportion of those invited did not take part. Some were referred to the programme but did not turn up. For confidentiality reasons, it was not possible to explore why.
Only one researcher gathered the data. The researchers acknowledge there is a risk of over-diagnosis of DLD. Therefore a random sample was checked by an independent assessor. We don’t know whether or not this threw up any disagreements.
There is some uncertainty around the extent of the effect, due to the sample size. This is reflected in the wide confidence interval. However, it’s well clear of the “line of no difference”, it looks clinically important and therefore cannot be ignored. The broad finding is consistent with other evidence in this area.
Join us around the campfire to discuss this paper
The elves are organising an online journal club to discuss this paper with first author Dr Maxine Winstanley, Dr Richard Church and our good friends at ACAMH (the Association of Child and Adolescent Mental Health). We will discuss the research and its implications. The webinar will be facilitated by André Tomlin (@Mental_Elf).
The focus will be on critical appraisal of the research and implications for practice. Primarily targeted at CAMHS practitioners, and researchers, ‘CAMHS around the Campfire’ will be publicly accessible, free to attend, and relevant to a wider audience.
It’s taking place at 5-6pm GMT on Monday 1st March and you can sign up for free on the ACAMH website or follow the conversation at #CAMHScampfire. See you there!
Interested in learning more about research surrounding Developmental Language Disorder & #youthjustice?
Join @DrMaxineW @Mental_Elf @McPinYPNetwork @DBadenoch for our 3rd #CAMHScampfire.
Book for FREE on our website https://t.co/WPszS8jZt2 #devlangdis pic.twitter.com/gIg3bEZKbE
— Association for Child & Adolescent Mental Health (@acamh) February 26, 2021
Conflict of interest
Winstanley, M., Webb, R.T. and Conti‐Ramsden, G. (2020), Developmental language disorders and risk of recidivism among young offenders. J Child Psychol Psychiatr. https://doi.org/10.1111/jcpp.13299