Introducing the SLI debate

It is my great pleasure to introduce this special issue on specific language impairment (SLI). The special issue re-examines the diagnostic criteria for SLI and questions whether the term ‘SLI’ should continue be used as a diagnostic label for children with ‘unexplained language problems’ (the term used by Bishop 2014 in her lead article). This special issue has come about because of increasing dissatisfaction in many quarters with the wide variability in the diagnostic criteria used and the labels given to children with unexplained language problems. This variability is contributing to a lack of equity of access to services and limited recognition and understanding of children’s language problems both by the general public and the scientific community (Bishop 2010). Recent population studies (e.g., Tomblin et al. 1996, Reilly et al. 2010) allow examination of the validity of the diagnostic criteria from a new perspective and thus reconsideration of our use of these criteria is timely. The debate about labels has been highlighted by the exclusion of SLI in the recently published Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association 2013), as recommended by the American Speech and Hearing Association (ASHA). ‘Language Disorder’ is used instead. The International Classification of Diseases and Related Health Problems (ICD-11), currently in preparation, is also unlikely to use ‘SLI’. In the UK, a live debate entitled ‘What is Specific Language Impairment?’ in May 2012 raised several issues about diagnostic criteria, labels and services. The main issues regarding diagnosis were: the role of nonverbal IQ in diagnosis of language problems, differential diagnosis from autistic spectrum disorder (ASD) and the label that should be used for children with unexplained language difficulties. The debate also revealed that diagnostic labels and criteria were being used creatively in disputes over access to services both by those seeking to obtain services for children (often parents and their lawyers) who could be accused of ‘diagnostic shopping’ and also by those seeking to deny services (often due to financial constraints) who may use particularly restrictive criteria in order to reduce the number of children qualifying for services (see also Wright 2014). Videos and slides from the debate can been viewed at http://www.moorhouseschool.co.uk/sli-debate/.