The DVD debate - Afasic

As we have seen with the SLI Debate, terminology in the field of paediatric speech and language therapy can be a problematic issue. The term DVD (Developmental Verbal Dyspraxia) has been widely used for some time, but has always raised questions. Is it an appropriate term to use for children? Is it ever an accurate diagnosis? Does it even exist?

Over the next few months, we will be featuring a number of contributions from a range of experts with differing viewpoints. In the first article (below) Sean Pert argues that, in most cases, the term ‘Inconsistent Phonological Disorder’ (IPD)  more accurately describes children’s difficulties.

Do leave a comment to let us know what you think.

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Speech disorder in young children by Dr Sean Pert (269.7 KiB, 438 hits)

7 comments on “The DVD (Developmental Verbal Dyspraxia) Debate

  1. Very dated, old, research references used to explain the issues.
    No mention of Auditory Processing Disorder (APD) which can be a major cause of phonological processing problems.
    There needs to be a multi – discipline approach to the multiple issues that can cause these types of issues. And using more recent international research regarding multiple languages, and speech acquisition.

    • The age of research is not relevant here; many seminal papers are old. It is only relevant if the papers are peer reviewed and the findings of the papers quoted here have not been disproven. In fact, they have stood the test of time and are therefore strong evidence.
      APD is itself a highly controversial diagnosis; and I note that you are a researcher in this field.
      As an NHS therapist for more than twenty years I always worked in a team with specialist teachers, educational psychologists, paediatricians and other professionals.
      I am also an advisor for the Royal College of Speech and Language Therapists on bilingualism and have published one of the few assessments in a language other than English. The research team showed that both the categories of speech disorder and the interventions worked with children who spoke languages other than English and bilingual/multilingual children.

  2. I find this analysis extraordinary and unhelpful. What is to be gained by questioning whether something that can be defined by a group of features exists, where there are children that clearly fit within the feature list and there is very specific published therapy treatment approach that is shown to benefit those children (NDP3)? The features are clearly outlined in the RCSLT policy statement https://www.ndp3.org/documents/rcslt2011dvdPolicyStatement.pdf. I don’t get why you would bunch these children in with a broader group of children who have lesser difficulties and then recommend an approach for treatment that is less suitable for the children with the more severe disorder. Or are you trying to suggest the Core Vocabulary approach is as valuable for the children who display all the features of Verbal Dyspraxia and that your belief is group therapy doing Core Vocabulary approach is as valuable for those children as one to one therapy with a specialist at delivering the NDP3 programme? I can assure you my child made no progress in group therapy where the focus was on pronouncing words and then came on significantly working with the specialist speech therapist on a one to one breaking down speech into the individual sounds and working on sequencing these back into words. It is ludicrous to suggest working on Core Vocabulary is going to fix a child who struggles with almost every sound and sequencing these back into words. Ours are children with severe speech disorder and your analysis reads like a propaganda sheet for justification why services should be cut for this group of children. Given that these children are already incredibly vulnerable and getting the services that they need for them is already hugely difficult and even with the right approach it can take years for these children to overcome their difficulties, I’m really worried that your suggested approach could cost children their opportunity to learn to speak and I worry about Afasic promoting this view.

    • Hi Hayley,
      Just to reiterate that Afasic is not promoting this view. As we make clear, we are hosting a debate on the subject and hope to include a range of views from experts with varying opinions. Thank you for your robust contribution and we would encourage other parents, therapists and any other interested party to let us know what they think.
      Alison

    • A list of diagnostic features means that children are diagnosed by exclusion (If it’s not X or Y then it must be Z). This was the approach used in Specific Language Impairment (SLI) diagnosis and this has been shown to be highly problematic and diagnosis by exclusion has now been rejected by the research community, with the SLI diagnosis changed to Developmental Language Disorder (DLD). We should therefore be very wary of a diagnostic label which uses a cluster of features, especially when such small numbers of children are involved.
      There was not room in the article to explore the issues you raise; Group therapy has been consistently shown to be as effective as individual therapy in speech and language therapy. This doesn’t mean that there isn’t a place for individual therapy, just as in school, children benefit from both individual and group activities for learning. The delivery method is thought to be less important than the content.
      Individual experiences are important and I am so pleased that your child has made progress. However, the article is aimed at the assessment of all children with speech sound difficulties and how speech and language therapists arrive at a diagnosis.
      I have always supported services for children, being a speech and language therapists working in the NHS, and the article is based on the evidence we have.
      I wrote the article precisely because children may be missing out on the correct diagnosis and therefore the correct treatment.

  3. After reading Dr Perts article and reasons for debate, i thought i would put my views on this. My Child had great Difficulty to say T,D,N sounds, for approx 2 years he had core vocabulary therapy, which did NOT help. After 2 years, there was no improvement. They chose words he liked, one of them Helicopter, where he could not say T but there was a K sound in it as well. We visited the Nuffield and was provided with help, and in a relatively short time, they changed his articulation. He learned to lift his tongue up whilst making sounds. So According to DR Pert my childs difficulties did not exist at all!!! This is an extremely sad article which can upset many a parents who have witnessed first hand, how Verbal Dyspraxia affects their child.

    • I am so pleased that your child made progress.
      The article is based on research and highly specialist clinical practise over twenty years. I completely accept that your child had the difficulties you describe. I simply think we need to think about these difficulties in a different way. The approaches outlined do not exclude articulation work, and it is important to understand that speech disorders may include several levels of breakdown in the speech system. This might include difficulty producing sounds physically (articulation) and difficulty using sounds in words (phonology). I do carry out articulation work if a child is not stimulable (cannot produce the individual sounds). This would not prevent phonology work in addition if detailed assessment showed that there were difficulties at several levels. This is what I would suspect in your child’s case. When teaching my students I emphasise detailed assessment, leading onto therapy or therapy combination approaches. One of the motivations for this article is that speech and language therapists often only have the training or resources or time to try only one approach.
      I am not detracting from your family’s experience. I have worked with many many children with very severe speech difficulties and know how distressing this is. However, I am challenging current thinking so that the profession and researchers can find the best way to help children with these difficulties, so that the children can recover more quickly.

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