DLD and Comprehension | How to Assess this Hidden but Vital Skill

DLD and Comprehension | How to Assess this Hidden but Vital Skill

Written by Emily Dawes | Speech language pathologist

comprehension, how hard can it be

Comprehension – it’s the area of language you feel most confident with, right? For many clinicians the answer is probably ‘no!’. But why do we lack confidence in comprehension?

The short answer is that comprehension is an incredibly complex and hidden skill. This makes it difficult to clearly conceptualise, measure (assess), and target in intervention (without access to real-time brain imaging!).

I think it is important that we are focusing on comprehension more in both clinical practice and research. Oral language comprehension is an area which continues to be under-researched (as noted by Law, Garrett, and Nye back in 2004), despite the significance of language comprehension to communication, learning, and long-term outcomes. While we have learned a lot from research focused on reading comprehension, we still have many gaps in our understanding of oral language comprehension, and how to improve it.

What does the research say about comprehension?

Comprehension-guru Professor Dorothy Bishop wrote this seminal text on comprehension back in 1997 which I highly recommend to anyone who wants to learn more about comprehension (Uncommon Understanding, updated revision in 2014 – see here.)

Understanding comprehension

In thinking about comprehension and trying to make what is indeed a highly complex array of processes and skills into something clinically tangible, I have broken down comprehension into three broad levels.

  1. Word level comprehension
  2. Sentence level comprehension
  3. Discourse level comprehension (please don’t forget discourse comprehension!!)

I find that thinking about comprehension in terms of these levels is helpful in working out some of the key skills that we may want to assess and target in clients with comprehension difficulties, such as individuals with Developmental Language Disorder (DLD).

DLD and Comprehension

Word Level Comprehension

Firstly, words – the key word here is… vocabulary!

Whether we are comprehending single words, sentences (including following instructions), or forming a coherent understanding at the discourse level, we need to have robust vocabulary knowledge. This means both breadth (the number of words we know) and depth (how well we know those words). There are many amazing vocabulary researchers around if you want to learn more about vocabulary development, breadth, and depth.

Intervention may involve explicit vocabulary instruction aiming to build good semantic organisation via vocabulary breadth and depth. Morphology is an area of increasing recent research interest, and I look forward to seeing more intervention studies in this area (there are a few research papers which have been published recently if you are interested). I would recommend listening to the fantastic The Talking DLD podcast on vocabulary here, and reading Bringing Words to Life by Isabel Beck and colleagues.

Sentence Level Comprehension

Secondly, sentences. Key here are grammatical skills and phonological short-term memory.

We must have a robust understanding of the grammar of the language/s we are listening to or reading for successful comprehension. We also need to be able to hold the language we hear in our short-term memory long enough to process the overt (literal) message being communicated. During this stage, we need to access stored vocabulary and grammatical knowledge. We may also need to make some inferences by drawing on higher level skills such as the pragmatic context and our background knowledge.

Intervention may involve implicit and/or explicit approaches, depending on the age of your client and other factors (such as attention and language comprehension). Sentence coding approaches include Shape Coding (https://shapecoding.com/), and other colour-coded based approaches such as Alien Talk and Colourful Semantics that have a more semantic focus. A word of warning, while there are a range of tools available, they have varying levels of research evidence – so remember to draw on all principles of evidence-based practice when selecting appropriate approaches.  

You can read more about interventions targeting grammar…

  1. In this review by grammar-guru Dr Susan Ebbels (open access journal – https://journals.sagepub.com/doi/full/10.1177/0265659013512321).
  2. Take a look at this ah-mazing grammar intervention sequence guide here (https://www.theinformedslp.com/review/the-grammar-guide-you-never-knew-you-always-wanted).
  3. Listen to this in-depth The Talking DLD podcast (https://thedldproject.com/developmental-language-disorder-and-grammar-therapy/).

Discourse Level Comprehension

Thirdly, discourse (please don’t forget discourse – it is my favourite area!).

For many clients, including children with DLD, discourse level communication is often our peak functional goal – in terms of comprehension, engaging in discourse level communication may include understanding and following a conversation, watching a movie, or reading a book. Of course, discourse is the most complex level of comprehension as it involves a huge range of skills. We can’t easily ‘see’ and measure someone’s discourse comprehension – it is invisible and occurs rapidly in real-time.

Along with the skills previously mentioned for word- and sentence-level comprehension, critical factors for discourse comprehension also include many higher-level skills such as pragmatics, theory of mind, background knowledge, schema, and inferencing.


Once we start contemplating discourse level comprehension, we need to think about schema. Schema are the mental models we have stored in long-term memory which provide structures of familiar events, experiences, narrative genres and so on. Theoretically, when we are comprehending at the discourse level, we attach information to the relevant schema – the schema is like a scaffold which provides us with support to comprehend the discourse. If we do not have a relevant schema, or have poorly specified schema (i.e. think of a child with poor narrative macrostructure knowledge), then it is likely to negatively impact our comprehension


  1. Now on to inferencing – yes, you made the link. Inferential comprehension is critical for successful discourse comprehension. We need to make appropriate inferences to establish and maintain coherence between sentences (local coherence) and across the discourse as a whole (global coherence). As competent adult communicators, we make (generally appropriate and successful) inferences all the time – or we are well aware when we don’t! If you are familiar with the TV show ‘The Big Bang Theory’ you will have seen many instances in which the character Sheldon does not make necessary inferences, which lead to a comprehension breakdown. Children with poor oral and reading comprehension may have difficulty with making either, or both, types of inference – and we know that both local and global inferences are important markers of good comprehenders (Cain and Oakhill, 1999).

A requirement underlying the ability to draw appropriate inferences is relevant background knowledge, an essential component for successful oral and written discourse comprehension. If we do not have the adequate, relevant and required background knowledge, then our comprehension is going to suffer (Smith, Snow, Serry, and Hammond, 2021).

Intervention to improve discourse level comprehension needs to target a variety of skills, and we still need a lot more intervention research in this area. Depending on the client, their goals and their oral language skills, some areas that can be targeted include:

  1. Supporting and developing relevant background knowledge.
  2. Building robust schema by targeting relevant discourse macrostructures (i.e. using story grammar icons to represent fictional narrative macrostructure).
  3. Interactive shared book reading using think-alouds to model comprehension processes, discussion to support both literal and inferential comprehension of the story, and theory of mind (citing my own research here – Dawes, Leitão, Claessen, and Kane, 2019). Shared book reading is also a useful context to focus on other language targets (such as vocabulary or grammar).

A sidenote here – it’s critical we remember that literal and inferential comprehension are distinct (but related) skills – very often, speechies and teachers view them as a single hierarchy. We then only focus on literal comprehension (e.g. such as Blank levels I and II) with children who have weak comprehension skills, thereby neglecting inferential comprehension which is actually a separate (and critical) skill. We can and should target and support both literal and inferential comprehension!

DLD & Comprehension Summary

We can integrate many of these skills across the word-, sentence-, and discourse-level during intervention – think whole à part à whole, with our overall ‘whole’ goal often being functional discourse-level communication. Also, these are all areas which teachers can and should focus on in the classroom as they are beneficial for all students. We know that oral language comprehension underlies reading comprehension, so we should be promoting good oral discourse comprehension from a young age to prevent and minimize poor reading comprehension (and its potential impacts) later on.

Some additional considerations for comprehension include being aware of:

  1. Comprehension monitoring skills (this is an area of difficulty for many young children with DLD),
  2. Other cognitive skills which impact comprehension, which include (but are not limited to) attention, executive functioning, and working memory.

This certainly is not an all-encompassing blog on comprehension, but I hope that it proves to be of some use in helping to unpack this complex area of language. Remember to always be guided by the best available evidence and theory, and look to those aforementioned gurus for more information. For those of you interested in additional reading, see some great books and research papers below. Thanks for reading!

About the Author - Emily Dawes

Emily Dawes is a speech language pathologist who works at a specialist school for young children with Developmental Language Disorder (DLD) in Western Australia. Her role involves supporting students and providing outreach support to teachers in mainstream schools. Her research and publications have focused on comprehension in young children with DLD and working memory in poor readers. She is passionate about the translation from research to practice and providing accessible and clinically applicable, evidence-based resources for speech language pathologists and educators.


Bishop, D. (2014). Uncommon Understanding: Development and Disorders of Language Comprehension in Children (Classic ed.). Hove: UK: Psychology Press.

Cain & Oakhill (Eds.) (2007) Children’s Comprehension Problems in Oral and Written Language: A Cognitive Perspective. New York: The Guilford Press.

Open Access Papers

Dawes, E., Leitão, S., Claessen, M., & Kane, R. (2019). A randomized controlled trial of an oral inferential comprehension intervention for young children with developmental language disorder. Child Language Teaching and Therapy, 35(1), 39–54. https://doi.org/10.1177/0265659018815736

Smith, R., Snow, P., Serry, T., & Hammond, L. (2021) The Role of Background Knowledge in Reading Comprehension: A Critical Review, Reading Psychology, 42:3, 214-240, DOI: 10.1080/02702711.2021.1888348

Tarvainen, S., Stolt, S., & Launonen, K. (2020). Oral language comprehension interventions in 1–8-year-old children with language disorders or difficulties: A systematic scoping review. Autism & Developmental Language Impairments. https://doi.org/10.1177/2396941520946999

Other papers

Cain, K., & Oakhill, J. (1999). Inference making ability and its relation to comprehension failure in young children. Reading and Writing: An Interdisciplinary Journal, 11(5), 489-503. doi:10.1023/A:1008084120205

Law, J., Garrett, Z., & Nye, C. (2004). The efficacy of treatment for children with developmental speech and language delay/disorder: a meta-analysis. Journal of speech, language, and hearing research : JSLHR47(4), 924–943. https://doi.org/10.1044/1092-4388(2004/069)

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