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Tyler T. Christopulos Ph.D., CCC-SLP
University of Utah

What does it mean to be “at-risk”?

What does it mean to be “at-risk“?

“Risk” means the chance that something is dangerous. For example, smoking is considered a risk for lung cancer. That means people who smoke have a greater chance of getting lung cancer than people who don’t. The word “chance” is important. People who smoke “might” get cancer, and those who don’t “might not,” but neither is guaranteed. Because many people who smoke get lung cancer, it is widely accepted that smoking puts people at-risk.

People can choose not to smoke (although it can be very hard to stop once addicted), but many risks are not under our control. For example, people with poor diets are more at risk for health problems than people who eat nutritious foods.1, 2 However, a person may desire a healthy diet but lack the money or transportation to regularly access healthy food.

Smoking and diet affect our bodies in direct ways. However, risks do not always directly cause a problem; instead, they may be correlated with the problem. Consider this story.

  • A tired boy has been playing games on his phone for 10 hours.
  • His mom takes away his phone.
  • The boy becomes angry.

What caused the boy to become angry? More than likely, his mom taking away his phone caused him to become angry. We also learned that the boy was tired. Did this cause the boy’s anger? It is easy to imagine the boy getting angry even if he was not tired. Fatigue may be correlated with anger, but not necessarily the cause. In other words, fatigued people may be at higher risk for anger than well-rested people. Note that a person may experience more than one risk factor. What if the boy was not only tired but also hungry? He might be at even higher risk for anger. Risk factors are environmental or biological factors associated with a particular disorder, but whose causal relationship to the problem may be unclear, in other words – correlations3.

What risk factors are related to DLD?

At this time, we cannot say with certainty what causes DLD. However, researchers have identified several risk factors, or correlations, that parents should be aware of. These include having a family history of speech, language or learning disorders; being male; being a younger sibling in a large family; having parents with few years of education; and having dyslexia.3,4,5,6,7 Consider dyslexia. Certainly, we can find examples of children who have dyslexia yet do not have the pervasive language problems that come with DLD. And many children with DLD do not have dyslexia. Still, these individual exceptions do not change the fact that in large numbers of people, scientists have found that people with dyslexia are more likely to have DLD than those who don’t have dyslexia. The idea of risk is useful for clinicians in figuring out what factors to pay attention to when diagnosing and treating.

Although some risk factors are stronger predictors than others, in general, a person with many risk factors would be more likely to have DLD than a person with one or two of them.

To summarize:

  • Risks increase the chances of having DLD. More risks make the chances higher than fewer risks.
  • Often risks are out of our control, so there is no need for guilt if you or your child have DLD.
  • We have not yet identified all of the possible risk factors associated with DLD, so sometimes, people will have DLD even though they don’t seem to be at-risk.

What does this mean for families? If you suspect your child has DLD, seek help whether or not any risk factors are present. If your child has risk factors, but you do NOT see evidence of DLD, remain watchful, especially if there are multiple risk factors. Sometimes DLD is diagnosed later in childhood or even in adulthood when the language demands of school or work become too challenging. In either case, you can seek the professional help of a Speech-Language Pathologist who is an expert in making recommendations, providing a diagnosis if needed, and offering treatment, support, and direction.


References

  1. “Poor Nutrition.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 24 Aug. 2020, www.cdc.gov/chronicdisease/resources/publications/factsheets/nutrition.htm.
  2. Behrman, J. R. (1996). The impact of health and nutrition on education. The World Bank Research Observer, 11(1), 23-37.
  3. Bishop, D. V., Snowling, M. J., Thompson, P. A., Greenhalgh, T., Catalise‐2 Consortium, Adams, C., … & Boyle, C. (2017). Phase 2 of CATALISE: A multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology. Journal of Child Psychology and Psychiatry, 58(10), 1068-1080.
  4. Michaelson, J. Potential causes of Developmental Language Disorder. Retrieved from https://dldandme.org/potential-causes-of-developmental-language-disorder/
  5. Rice, M.L., Taylor, C.L., Zubrick, S.R., Hoffman, L., Earnest, K.K. (2020)2 (PDF) Heritability of Specific Language Impairment (SLI) and Non-specific Language Impairment (NLI) at ages 4 and 6 years across phenotypes of speech, language, and nonverbal cognition. JSLHR, 63, 793-813, doi.org/10.1044/2019 PMID: 32163317.
  6. Zubrick, S.R., Taylor, C.L., & Christensen, D. (2015). Patterns and predictors of language and literacy abilities 4–10 years in the Longitudinal Study of Australian Children. PLoS ONE, 10, e0135612.
  7. Rudolph, J. M. (2017). Case history risk factors for specific language impairment: A systematic review and meta-analysis. American journal of speech-language pathology, 26(3), 991-1010.