Persistence of the developmental language disorder diagnosis, neurodevelopmental trajectories and attendance at offered interventions

Abstract

Aim

To study the diagnostic stability of developmental language disorders, other neurodevelopmental disorders and interventions received until age 6 years in children who screened positive for language delay, but not for autism, at age 2.5 years.

Methods

In 2016, in Gothenburg, Sweden, 100 monolingual or multilingual children underwent language assessment at a mean age of 2.9 years. At age 6 years, 85 of these children underwent language assessment. A review of paediatric records was performed after the clinical assessment to obtain information about other neurodevelopmental disorders and interventions received.

Results

At age 6 years, 74/85 (87%) of the children had persistent language disorders, and 20/85 (24%) had been diagnosed with at least one additional neurodevelopmental disorder. Five of them had autism. In general, families only attended half of the offered intervention sessions irrespective of intervention type and no difference between monolingual and multilingual families was found.

Conclusions

The persistence of language disorder and the presence of later additional neurodevelopmental disorders highlight the importance of longitudinal and multidisciplinary monitoring of children with delayed language development. Further studies and analyses are warranted to investigate the reasons behind the poor attendance rate for interventions offered.

Abbreviations

AAC

augmentative and alternative communication

ADD

attention‐deficit disorder

ADHD

attention‐deficit hyperactivity disorder

CHS

Swedish child health services

DLD

developmental language disorder

ESSENCE

early symptomatic syndromes eliciting neurodevelopmental clinical examinations

IF

intellectual function

NDD

neurodevelopmental disorders

NP

neurodevelopmental

SLP

speech and language pathologist

SSD

speech sound disorder

T1

timepoint 1

T2

timepoint 2

Key notes.

• Screening positive for language delay, but not autism, at age 2.5 years is associated with a high rate of persisting language disorders at age 6 years.

• Nine of 10 children had persistent language disorders, but attendance at offered interventions was only 50% among the families.

• One in four children met the criteria for additional neurodevelopmental disorders 3 years after being identified as having language delay.

1. INTRODUCTION

Developmental language disorder (DLD) is a neurodevelopmental disorder and is common in pre‐school children, affecting 7%–8% of the general population according to Western studies. ¹ , ² About 2.5% of individuals with language disorders also have other neurodevelopmental disorders or neurological disorders such as autism or epilepsy, which have a notable impact on the affected children. Hence those children's language difficulties must be considered in the light of these co‐existing conditions. ³ However, this categorical division is problematic, since longitudinal research shows that children who had DLD at age 2.5 years often had other neurodevelopmental disorders at early school age. ⁴

Several studies have shown that language difficulties persist over time. One study showed that language difficulties identified at age 4 years persisted a year later. ⁵ An Australian study, conducted with the Raine Study cohort consisting of 1626 children, ⁶ reported a prevalence of 6.4% at age 10 years, confirming that language difficulties observed in children at age 1–3 years persist at school age. ⁵ Young adults with a history of DLD tend to struggle academically, which often manifests in difficulties related to spelling, reading and mathematical problem solving. ⁷

One important aspect to consider when monitoring children with late language development is the overlap with other neurodevelopmental problems for example behaviour. In addition to Swedish studies showed that language delay at age 2.5 years was associated with lower intellectual functioning. ⁸ In fact, 40% of those with language delay identified through early screening had at least one other neurodevelopmental disorder, including autism, ⁴ at age 7 years. An Australian study showed that population‐based screening for language delay followed by parental education was feasible and acceptable. ⁹

Previous studies of DLD prevalence have overlooked multilingual children. In the present case, multilingual children are those who speak one or more languages, typically as native languages, besides Swedish. ¹⁰ There is a need for research that encompasses multilingualism, given the diverse ethnic composition of the contemporary Western world. It is important to emphasise that multilingualism in itself does not appear to be a risk factor for DLD. ¹¹ However, if children do have DLD, this affects their proficiency in all their languages. ¹² The quality and quantity of exposure to a second language are crucial.

At the Child Health Services (CHS) in Gothenburg, Sweden, almost all children are concurrently screened for language and autism at age 2.5 years. If they pass the autism screening ¹³ but fail the language screening, they are referred to a speech and language pathologist (SLP) for assessment and intervention. ¹⁴ Language assessments can provide valuable insights, but it is equally crucial to examine children's functional language skills in their day‐to‐day life ³ to enable an effective intervention. Duration of treatment, frequency of sessions and individual or group administration are crucial variables to consider when planning an intervention. Existing research has shown evidence of the effectiveness of language and communication interventions in pre‐school children with DLD, ¹⁵ including phonological intervention ¹⁶ and targeted support for expressive language difficulties. ¹⁷ In the case of pre‐school children experiencing difficulties with both receptive and expressive language skills, evidence supports instructing parents to use a more responsive communicative approach with their child. ¹⁸ To ensure that such an approach is actually followed, it is suggested to use pictorial support and signs as a communicative supplement–that is, augmentative and alternative communication (AAC). ¹⁸

At the Paediatric Speech and Language Pathology Clinic (SLP Clinic) at the Queen Silvia Children's Hospital in Gothenburg, Sweden, children aged 2–7 years with a variety of speech and language problems are offered assessment and intervention. The interventions consist in counselling for parents regarding diagnosis, language tasks and occasionally motivational counselling to recommend referral for other assessments such as neurodevelopmental ones. A further indirect intervention for parents is a six‐session course in the responsive communicative approach ComAlong–augmentative and alternative communication ¹⁹ or a two‐session introduction to the field of AAC.

The children are offered to participate, with their parents, in group sessions focusing on language stimulation and responsiveness. Six sessions including playful language activities are demonstrated by two SLPs. There is also individual intervention–either language stimulation during 2–3 sessions or a phonologically based intervention during eight sessions, known as the ‘cycling approach’. ¹⁶

There is a lack of longitudinal studies of children with early identified DLD, but none of children screened positive at age 2.5 years for late language development and negative for autism. More studies about language abilities, interventions received and neurodevelopmental trajectories in these children are desirable. ²⁰ For this reason, we performed a language reassessment at age 6 years and also obtained information about other neurodevelopmental disorders diagnosed and interventions received in the meantime.

The overall aim of this study was to investigate diagnostic stability in children diagnosed with language disorders at age 2.5 years and followed up at age 6 years. We were also interested in studying the presence of neurodevelopmental disorders and language interventions offered during this age span and in finding out if there were differences between monolingual and multilingual children.

The following research questions were asked:

At age 6 years:

1. What language disorders do they have?

2. According to the paediatric records, have they been subject to other neurodevelopmental assessments and are there any co‐existing neurodevelopmental disorders or other medical diagnoses?

3. Did they participate in clinic‐based language interventions offered, if any?

4. Based on each research question, were there differences between monolingual and multilingual children?

2. MATERIALS AND METHODS

Children with DLD in Sweden are typically detected through the CHS language screening administered at age 2.5 years.

2.1. Participants

In 2016, more than 6000 children aged 2.5 years underwent language screening at CHS centres and 196 were consecutively referred to the SLP Clinic at the Queen Silvia Children's Hospital. From this group, 100 children (68 boys) were subsequently recruited by the first author to participate in the present study. At the SLP Clinic, they underwent language assessment before age 3 years (T1) whereupon 87 of them were diagnosed with mixed or expressive DLD. They were offered interventions by the SLPs after T1. ¹⁴ At age 6 years, (T2) 85 of them participated in a comprehensive follow‐up language assessment performed by experienced SLPs including the first and last authors. No notable differences were observed with regard to diagnosis, language background or gender between the group of 15 children who, for various reasons, declined to participate in the T2 study and the remaining 85 participants. ²¹ Further demographic data have been presented, please see Schachinger et al., 2024.

At T1, 52% of the 100 participating children were categorised with mixed DLD, 35% with expressive, and 13% with no language disorder. ²² Of the 85 children (55 boys) studied at T2, 48% were multilingual. Of those, 38% had several native languages. Mean age was 2.9 years at T1 and 6.0 years at T2.

2.2. Procedure

A thorough review of paediatric records was performed to retrieve information from assessments of other neurodevelopmental disorders that often include language assessment such as autism evaluation. Information about neurodevelopmental diagnoses and interventions offered between 2.5 and 6 years of age was also obtained. This was done within a year from T2. The focus of the systematic review of the paediatric records was on three variables. The first contained referrals for neurological, neurodevelopmental, motor functioning or intellectual functioning assessment. The second contained results obtained from assessments of neurodevelopmental disorders. The third variable contained interventions administered at the SLP Clinic.

2.3. Statistical analyses

All data were analysed using the SPSS Statistic version 29 for Windows (IBM Corp). To compare two or more sub‐groups with categorical variables, Pearson's Chi‐square test and Fisher's exact test were used. The analysis of attrition from T1 to T2 (n = 15) was assessed using Chi‐square and Fisher's exact tests.

3. RESULTS

3.1. Persistent language disorders

Diagnostic stability regarding DLD from age 2.9 years (T1) to age 6 years (T2) is presented in Figure 1.

FIGURE 1.

Diagnostic stability from age 2.9 years (n = 100) to age 6 years (participated n = 85, declined n = 15). DLD, developmental language disorder, mixed DLD, receptive and expressive DLD; No DLD/SSD, no language disorder; SSD, speech sound disorder.

Results revealed that, in the mixed DLD group, 41 of the original 52 children (79%) participated in the follow‐up study at T2. Of these children, 38 (93%) still had a DLD diagnosis, but one (2%) had speech sound disorder (SSD) and two (5%) had no language disorder.

In the expressive DLD group, 33 of the original 35 (94%) participated at T2. Of them, 24 (73%) still met the criteria for DLD, three (9%) had SSD and six (18%) no longer had a language disorder diagnosis.

In the group with no language disorder at T1, 11 of the original 13 (85%) participated at T2. Six of them (55%) now met the criteria for DLD, two (18%) met the criteria for SSD and the remaining three (28%) still had no language disorder. Of the children who did not receive any language disorder diagnosis at T1, 10 (77%) were monolingual and three (23%) were multilingual. At T2, three (27%) of those 11 who participated met criteria for other neurodevelopmental disorders, one case each of developmental co‐ordination disorder, autism and attention‐deficit hyperactivity disorder (ADHD), according to the review of the paediatric records. One of them also had DLD. All three children were monolingual.

3.2. Additional assessments and neurodevelopmental disorders

Of the 85 children in the study group, 32 (38%) had undergone additional external assessment. Ten children underwent a neurodevelopmental assessment, three children a cognitive assessment and 19 children both. Concerning other neurodevelopmental diagnoses, the review showed six children with ADHD, two with autism and three with both ADHD and autism. Two children were diagnosed with intellectual disability and three with learning disabilities. Selective mutism, epilepsy, anxiety, submucous cleft palate, Ehlers–Danlos syndrome and hearing impairment were diagnosed in one child each.

Other diagnoses were represented at age 6 years in both the DLD group and the no DLD/SSD group, but not in the SSD group. No statistically significant differences were found between the three diagnostic sub‐groups: DLD, SSD and no DLD/SSD (Table 1).

TABLE 1.

External assessments and diagnosis divided into diagnostic subgroups at age 6 years.

	Total	DLD	SSD	No DLD/SSD
	n = 85(%)	n = 68(%)	n = 6(%)	n = 11(%)
External assessment outside the SLP Clinic
IF assessment (by CHS)	3 (4)	3 (4)	0	0
NP assessment	10 (12)	8 (12)	0	2 (18)
Both IF and NP assessment	19 (22)	18 (26)	1 (17)	0
Neurology assessment	8 (9)	6 (9)	1 (17)	1 (9)
Physiotherapy assessment	3 (4)	2 (3)	0	1 (9)
Oral motor assessment	5 (6)	5 (7)	0	0
Occupational therapist assessment	3 (4)	3 (4)	0	0
Other diagnosis at 6 years	20 (24)	17 (25)	0	3 (27)
Autism	2 (2)	2 (3)	0	0
Autism + ADHD (ADD)	3 (4)	2 (3)	0	1 (9)
ADHD	6 (7)	5 (7)	0	1 (9)
Intellectual disability	2 (2)	2 (3)	0	0
Learning disability	3 (4)	3 (4)	0	0
Selective mutism	1 (1)	0	0	1 (9)
Anxiety disorder	1 (1)	1 (1)	0	0
Submucous cleft palate	1 (1)	1 (1)	0	0
Hearing impairment	1 (1)	1 (1)	0	0
Epilepsy	1 (1)	1(1)	0	0
Ehlers‐Danlos syndrome	1 (1)	0	0	1 (9)

Abbreviations: ADD, attention‐deficit disorder; ADHD, attention‐deficit hyperactivity disorder; CHS, Child Health Services; DLD, developmental language disorder; IF, intellectual function; NP, neurodevelopmental; SLP, Paediatric Speech and Language Pathology Clinic; SSD, speech sound disorder.

Multilingual children were more likely than monolingual ones to have been referred and assessed for both neurodevelopmental problems and intellectual functioning. In fact, 13 multilingual children (32%) versus six monolingual ones (14%) had been doubly assessed. The review of paediatric records showed that 20 (24%) children in the overall cohort had received an additional neurodevelopmental disorder or medical diagnosis at age 6 years. This included nine (20%) monolingual children and 11 (27%) multilingual children, with no noteworthy difference in the rate of additional diagnoses between the two groups.

There was no significant difference regarding external assessments between monolingual and multilingual children (Table 2).

TABLE 2.

External assessments and other diagnosis divided into mono‐and multilingual children and at age 6 years.

	Total	Monolingual	Multilingual
	n = 85 (%)	n = 44 (%)	n = 41 (%)
External assessment outside the SLP Clinic
IF assessment (by CHS)	3 (4)	0	3 (7)
NP assessment	10 (12)	4 (9)	6 (15)
Both IF and NP assessment	19 (22)	6 (14)	13 (32)
Neurology assessment	8 (9)	4 (9)	4 (10)
Physiotherapy assessment	3 (4)	3 (7)	0
Oral motor assessment	5 (6)	0	2 (5)
Occupational therapist assessment	3 (4)	1 (2)	2 (5)
Other diagnosis at 6 years	20 (24)	9 (20)	11 (27)
Autism	2 (2)	0	2 (5)
Autism + ADHD (ADD)	3 (4)	2 (5)	1 (2)
ADHD	6 (7)	3 (7)	3 (7)
Intellectual disability	2 (2)	1 (2)	1 (2)
Learning disability	3 (4)	0	3 (7)
Selective mutism	1 (1)	1 (2)	0
Anxiety disorder	1 (1)	1 (2)	0
Submucous cleft palate	1 (1)	0	(2)
Hearing impairment	1 (1)	1 (2)	0
Epilepsy	1 (1)	0	1 (2)
Ehlers‐Danlos syndrome	1 (1)	1 (2)	0

Abbreviations: ADD, attention‐deficit disorder; ADHD, attention‐deficit hyperactivity disorder; CHS, Child Health Services; IF, intellectual function; NP, neurodevelopmental; SLP, Paediatric Speech and Language Pathology Clinic.

3.3. Type of language interventions and frequency of attendance

In the total group, 67 (79%) of the children's families agreed to participate in an intervention. The participation in interventions among the diagnostic subgroups is presented in Table 3.

TABLE 3.

Type and frequencies of interventions offered at the SLP Clinic divided into diagnostic subgroups at age 6 years.

Intervention	Total n = 85 (%)	DLD n = 68(%)	SSD n = 6 (%)	No DLD/SSD n = 11 (%)
Active contact at the SLP Clinic	21 (25)	17 (25)	2 (33)	2 (18)
Initial accepted intervention	67 (79)	56 (82)	5 (83)	6 (55)
Participated in intervention	46 (54)	40 (59)	4 (67)	2 (18)
Child intervention
Group	20 (24)	18 (26)	1 (17)	1 (9)
Mean of sessions	3	3	9 a	0
Individual	14 (16)	11 (16)	2 (33)	1 (9)
Mean of sessions	3 b	2 b	8	3
Intervention to parents
Counselling	40 (47)	32 (47)	3 (50)	5 (45)
AAC	26 (31)	21 (31)	1 (17)	4 (36)
Mean of sessions	1	1	2	1
ComAlong	1 (1)	1 (1)	0	0
Mean of sessions	5	5	0	0

Abbreviations: AAC, augmentative and alternative communication; ComAlong, augmentative and alternative communication; an education for parents in the responsive communicative approach; DLD, developmental language disorder; No DLD/SSD, no language disorder; SLP, Speech and Language Pathologist; SSD, speech sound disorder.

^a One child participates in two rounds of group interventions.

^b One child received 38 sessions and is not included in the mean.

Notably, one child received 38 sessions of phonological intervention, while the remaining children averaged two sessions each.

The total group of 85 children consisted of 34 (77%) monolingual children and 33 (80%) multilingual children. However, only slightly more than half of the group, or 46 children (54%), participated in interventions: 22 (50%) of the monolingual children and 24 (59%) of the multilingual children. This can be seen in Table 4.

TABLE 4.

Type and frequencies of interventions offered at the SLP Clinic divided into mono‐and multilingual children at age 6 years.

Intervention	Total n = 85 (%)	Monolingual n = 44 (%)	Multilingual n = 41(%)
Active contact at the SLP Clinic	21 (25)	10 (28)	11 (27)
Initial accepted intervention	67 (79)	34 (77)	33 (80)
Participated in intervention	46 (54)	22 (50)	24 (59)
Child intervention
Group	20 (24)	7 (16)	13 (32)
Mean of sessions	3	3	3
Individual	14 (16)	6 (14)	8 (20)
Mean of sessions	3 a	6 a	1
Intervention to parents
Counselling	40 (47)	22 (50)	18 (44)
AAC	26 (31)	19 (43)	7 (17)*
Mean of sessions	1	1	1
ComAlong	1 (1)	0	1 (2)
Mean of sessions	5	0	5

^a One child received 38 sessions and is not included in the mean.

Abbreviations: AAC, augmentative and alternative communication; ComAlong, augmentative and alternative communication; an education for parents in the responsive communicative approach; SLP, Speech and Language Pathologist.

*= p < 0.05.

Over time, parental education in AAC emerged as the most frequent intervention for the entire cohort. On average, families attended approximately half of the planned sessions in both the toddler group and parental education. As regards group versus individual interventions, where it should be noted that six children received both group and individual interventions, the parents of monolingual children participated to a statistically significantly higher extent than the parents of multilingual children in parental introduction to AAC: Chi‐square (1, N = 59) = 5.544, p = 0.034.

There was no statistically significant difference between the groups concerning individual intervention.

For 59 families, the contact with the clinic was terminated either by the SLP or by the family itself, as seen in Figure 2.

FIGURE 2.

Families with no further contact at the SLP clinic divided into mono‐ and multilingual groups. Diagnostic subgroups are presented for each of them. DLD, developmental language disorder; SSD, speech sound disorder.

The SLP terminated monolingual contacts to a significantly greater extent than multilingual contacts, as evidenced by the result of the Chi‐square test: Chi‐square (1, N = 59) = 5.544, p = 0.034.

4. DISCUSSION

At age 2.9 years, 52% of the children examined had been diagnosed with DLD. Of those, 80% maintained their DLD diagnosis at age 6 years. Our study thus reaffirms that DLD identified at an early age tends to persist. ⁴ , ²³ Although the CATALISE study ³ problematises early screening regarding uncertain diagnostic stability, other studies show that screening at age 2.5 years identifies DLD and that language difficulties often persist. ⁴ In the present study, the children screened positive for language delay but negative for autism. Hence, it might be expected that they would manifest a relatively low rate of severe persisting problems several years later. However, by age 6 years, 24% met the criteria for other neurodevelopmental disorders, such as autism. Further, of the 11 children among the original 100 participants who initially did not have any language disorder, eight met the criteria for a language disorder at the follow‐up assessment. This suggests that underlying language difficulties may not yet be apparent at age 2.5 years when the language screening is performed. Hence, it is important to monitor these children over time.

There is no consensus in the scientific community on whether early language screening is reliable, and hence it is not recommended in all countries. ³ Our present findings are in line with those of a previous longitudinal study in Sweden following children who, at age 2.5 years, screened positive for language delay, autism or both. ⁴ This suggests that many children who screen positive for language delay at age 2.5 years will meet other neurodevelopmental diagnostic criteria as they reach school age. Several studies show that there is an overlap between different neurodevelopmental disorders, ²⁰ , ²⁴ and in the Swedish general population about 10% of all children meet the criteria for a neurodevelopmental disorder diagnosis at school age.

With this in mind, a clinical methodology has been proposed: ESSENCE, which stands for Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations. ²⁵ Its emphasis is on identifying early symptoms that cause concern, and it advocates for initiating clinical neurodevelopmental assessments before the age of 3–5 years. ²⁵ According to ESSENCE, not only language difficulties or DLD but also difficulties in the domains of cognitive functioning, motor skills, sleep, eating, behaviour, social skills and activity levels can warrant interventions for other neurodevelopmental disorders, such as autism. ²⁶

At age 6 years, many of the children had been assessed on the basis of ESSENCE. This had not necessarily led to a diagnosis, but it had sometimes highlighted difficulties in areas other than language. Neurodevelopmental disorders often influence language ability, and distinguishing such disorders from language difficulties is vital to ensure targeted and effective interventions. Most researchers concur that early intervention is pivotal, and this study suggests that screening for language delay at age 2.5 years identifies not only children with DLD but also those with emerging additional neurodevelopmental disorders. ²²

Earlier studies reported autism, with or without intellectual disability, to be more prevalent in multilingual than monolingual children. ²⁷ However, our study did not confirm this finding. Our study group size may not be large enough to make generalised conclusions, but larger cohort studies are desirable to investigate this issue.

Moreover, those children who do not meet the diagnostic criteria for any neurodevelopmental disorder may also benefit from intervention. Close monitoring is crucial and best achieved through collaboration between pre‐school and relevant healthcare providers.

Finally, we found that parents and children did not always fully engage in the interventions offered. This warrants further analysis. One potential explanation could be that families with lower health literacy, often categorised as people who are hard to reach ²⁸ within the population, may face challenges in maintaining contact with the clinic. It may also be that the SLP failed to explain the importance and significance of the intervention. The importance of an intervention plan in which parents are involved cannot be emphasised enough. However, this hardly accounts for the entire picture. A more comprehensive investigation, for example, using semi‐structured interviews with parents or focus groups involving parents and others, could shed light on the underlying causes.

4.1. Limitations

This was a descriptive study with a relatively small study cohort and sub‐groups but drawn from a large population‐based pool. It is important to bear this in mind when interpreting the results. Language assessments and language diagnoses are dynamic and may change over time. Hence, it is important to consider them from the perspective of the child's everyday language function. Another limitation may be that some of the children may have received interventions at pre‐school or even from private external sites outside the hospital clinic. However, in Sweden, there are hardly any private providers of treatment for children with DLD. It is also important to acknowledge that the distribution and prevalence of neurodevelopmental diagnoses in our group may have evolved since the time of the review.

5. CONCLUSION

The children in the study were identified as having language problems but no other problems within the ESSENCE domain before the age of 3 years. Nevertheless, several of them were found to have additional neurodevelopmental disorders 3 years later. This highlights the importance of using holistic assessment including information from pre‐school to follow the children over time. Moreover, families did not always fully participate in the language interventions offered. This may of course have affected the likelihood of a positive development for the children concerned. The results of the study will be communicated to SLP clinics in Sweden, since they constitute pivotal information that can directly influence the protocols used by those clinics as well as the approaches used in other settings integral to a child's function in daily life.

AUTHOR CONTRIBUTIONS

Ulrika Schachinger Lorentzon: Conceptualization; investigation; funding acquisition; writing – original draft; methodology; project administration; formal analysis; writing – review and editing; data curation. Eva Billstedt: Writing – review and editing; data curation; formal analysis; supervision; conceptualization; methodology; visualization. Christopher Gillberg: Conceptualization; methodology; visualization; writing – review and editing; supervision. Carmela Miniscalco: Conceptualization; investigation; funding acquisition; writing – original draft; methodology; writing – review and editing; supervision; formal analysis.

FUNDING INFORMATION

This study was supported by grants from the Agreement on Medical Training and Research (ALF) in the Västra Götaland Region, the Groschinskys Memorial Fund, the Linnea and Josef Carlsson Foundation, the Solstickan Foundation, the Queen Silvia Children's Hospital Research Fund and the AnnMari and Per Ahlqvist Foundation.

CONFLICT OF INTEREST STATEMENT

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

ETHICS STATEMENT

The present study is a part of a larger project approved by the Swedish Ethical Review Authority: Ref. Nos. GU‐306‐17, T1045‐18 and 2022–03230‐02. It was carried out following the Declaration of Helsinki. The families were informed both orally and in writing before giving their consent.

Schachinger Lorentzon U, Billstedt E, Gillberg C, Miniscalco C. Persistence of the developmental language disorder diagnosis, neurodevelopmental trajectories and attendance at offered interventions. Acta Paediatr. 2025;114:829–837. 10.1111/apa.17494