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In WKU’s Department of Communication Sciences and Disorders, Dr. Brian Weiler is engaging students in his work to address a little-known disorder that affects the lives of millions of children in the U.S.: language impairment.

Approximately 7% of kindergarten-aged students suffer from Developmental Language Disorder (DLD), a term that describes a variety of conditions in which a child’s language skills are below what is expected for their age group. Though the condition can be tested for, and evidence-based treatments are available, leaving DLD untreated–or beginning treatment too late–can be detrimental to a child’s development.

“Children with DLD are more likely to experience a variety of developmental barriers inside and outside the classroom,” Dr. Weiler says. “DLD can inhibit academic achievement, make basic social interactions more difficult, and decrease a child’s employment options during adulthood.”

The power of early intervention

Dr. Weiler’s clinical, research and teaching focus is on understanding the linguistic profiles of children with DLD, as well as evaluating universal kindergarten language screening approaches in order to improve identification of children at-risk for DLD.

Because DLD can be hard to recognize (for example, there are no physical signs), children with DLD may not be identified in the school setting until several years or more have passed. By this time, the downstream effects of DLD (such as lower academic achievement and impaired oral language skills) have often become apparent. But with a prevalence rate of approximately 7% of kindergarten-aged students, Dr. Weiler emphasized that we cannot afford to wait until these symptoms present to begin treating DLD. In fact, Tomblin et al. (1997) reported that over two thirds of children with specific language impairment (the most common form of DLD) are not receiving any speech-language pathology services, a treatment rate that has not improved much in recent years.

A 1997 study showed that less than 1/3 of kindergarten children with specific language impairment (SLI) received appropriate treatment. This statistic has not shown much improvement in recent years, and emphasizes the importance of Dr. Weiler’s research.

Early screening can lead to early treatment, which can significantly alter the trajectory of a child with DLD for the better. “Early treatment for DLD has been shown to not only effectively address any language impairment a child might demonstrate, but it can also mitigate some of the adverse long-term effects DLD can have on a child’s life and development,” Dr. Weiler says. “The earlier the treatment, the better the long-term results tend to be.”

This leads to a fundamental question of Dr. Weiler’s research: how can we improve in identifying DLD at an earlier point in children’s lives?

Testing a kindergarten language screening

It is important to emphasize that children with DLD come from all races, ethnicities, countries, languages and socio-economic backgrounds. Thus, Dr. Weiler designed a study that took place in Bowling Green, KY across a diverse group of elementary schools in his search to find a feasible, valid, and easily-implemented approach to identifying children who may be at risk for DLD. This study tested the Quick Interactive Language Screener (QUILS), a screening tool that identifies kindergarteners at risk for DLD and is intended to minimize racial, cultural and socioeconomic biases. QUILS is automated and efficient, and can be easily taken on an iPad or computer with minimal adult supervision. All of these factors are important, because most schools typically have only one speech language pathologist.

A kindergarten-aged student takes the QUILS screening on a touch-screen computer. The QUILS tool is automated and efficient, and can be done with minimal adult supervision, making it a strong candidate for a universal tool for identifying children at risk for DLD.

Dr. Weiler’s study found that 16% of the primarily monolingual English speaking kindergartners screened with the QUILS fell below the passing score. In a clinical or educational setting, these are children who would be recommended for monitoring and/or additional language testing. In this way, the QUILS could be a simple and efficient way to screen for young children at-risk for developing DLD, and thus only those who are at-risk would require full testing.

“Waiting to act until children are referred to a specialist may not be the best route to identification,” Dr. Weiler says. “Instead, it most certainly could be beneficial to be proactive and identify children with DLD earlier by using universal screening tests.” The results of this study suggest QUILS could indeed be a strong candidate for a universal screening tool.

Inspiring future researchers

Several students assisted Dr. Weiler in conducting this study, including spotlight student Baylee Lackey. Dr. Weiler considers student mentorship to be instrumental in supporting future research in his field.

“Baylee has truly been a vital component to this project,” he says. “I have seen her clinical skills and critical thinking related to research grow considerably during her time with me. Research assistants like Baylee are wonderful examples of how engagement in projects like these can help students make connections between research and practice, which is critical for the implementation of evidence-based practice later in their careers.

For now, Dr. Weiler is continuing his work by following up with some of the children who participated in the QUILS screening and administering them a more comprehensive language assessment.  In doing so, he can better evaluate the accuracy of the QUILS for identifying DLD–and thus asses if it is a strong candidate for a screening tool that can assist with early identification moving forward.

For more information about SLI/DLD advocacy, please visit RADLD (Raising Awareness of Developmental Language Disorder) and DLD and Me.

Research support provided by a Kentucky Biomedical Research Infrastructure Network (KBRIN) Investigator Development Award grant (PI – Weiler) funded by the National Institute of General Medical Sciences (NIH-NIGMS; 8P20GM103436).