title: Specific language impairment: a convenient label for whom?
abstract: BACKGROUND
  The term 'specific language impairment' (SLI), in use since the 1980s, describes children with language impairment whose cognitive skills are within normal limits where there is no identifiable reason for the language impairment. SLI is determined by applying exclusionary criteria, so that it is defined by what it is not rather than by what it is. The recent decision to not include SLI in DSM-5 provoked much debate and concern from researchers and clinicians.
  
  
  OBJECTIVE
  To explore how the term 'specific language impairment' emerged, to consider how disorders, including SLI, are generally defined and to explore how societal changes might impact on use the term.
  
  
  METHODS
  We reviewed the literature to explore the origins of the term 'specific language impairment' and present published evidence, as well as new analyses of population data, to explore the validity of continuing to use the term.
  We support the decision to exclude the term 'specific language impairment' from DSM-5 and conclude that the term has been a convenient label for researchers, but that the current classification is unacceptably arbitrary. Furthermore, we argue there is no empirical evidence to support the continued use of the term SLI and limited evidence that it has provided any real benefits for children and their families. In fact, the term may be disadvantageous to some due to the use of exclusionary criteria to determine eligibility for and access to speech pathology services. We propose the following recommendations. First, that the word 'specific' be removed and the label 'language impairment' be used. Second, that the exclusionary criteria be relaxed and in their place inclusionary criteria be adopted that take into account the fluid nature of language development particularly in the preschool period. Building on the goodwill and collaborations between the clinical and research communities we propose the establishment of an international consensus panel to develop an agreed definition and set of criteria for language impairment. Given the rich data now available in population studies it is possible to test the validity of these definitions and criteria. Consultation with service users and policy-makers should be incorporated into the decision-making process.
authors.affiliation: Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Sheena
authors.initials: S
authors.lastname: Reilly
authors.forename: Bruce
authors.initials: B
authors.lastname: Tomblin
authors.forename: James
authors.initials: J
authors.lastname: Law
authors.forename: Cristina
authors.initials: C
authors.lastname: McKean
authors.forename: Fiona K
authors.initials: FK
authors.lastname: Mensah
authors.forename: Angela
authors.initials: A
authors.lastname: Morgan
authors.forename: Sharon
authors.initials: S
authors.lastname: Goldfeld
authors.forename: Jan M
authors.initials: JM
authors.lastname: Nicholson
authors.forename: Melissa
authors.initials: M
authors.lastname: Wake
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000145:classification / Q000175:diagnosis / Q000628:therapy; D002675:Child, Preschool; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004410:Dyslexia / Q000145:classification / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007360:Intelligence; D007805:Language Development Disorders / Q000145:classification* / Q000175:diagnosis* / Q000628:therapy; D007807:Language Tests; D012016:Reference Values; D012922:Social Change; D013223:Statistics as Topic
keywords: child language; language impairment; specific language impairment