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UTBILDNING FÖR ELEVER MED GRAV SPRÅKSTÖRNING EN FORSKNINGS- OCH KUNSKAPSÖVERSIKT Med.dr., leg. logoped 3.7.Sammanfattning språkstörning i skolåldern 5.1.Sammanfattning skolplacering och undervisningstyp 7.1.Sammanfattning språkstörning och flerspråkighet 8.Språkstörning vid andra tillstånd 8.1.Språkliga svårigheter vid hörselnedsättning 8.2.Språkliga svårigheter vid autismspektrumstörning 8.3.Språkliga svårigheter vid ADHD Som en del av utredning 2013:29 ”Kvalitet i utbildningen för elever med vissa funktionsnedsättningar” presenteras en forsknings- och kunskapsöversikt om grav språkstörning och en beskrivning av angelägna områden för framtida svensk forskning. Översikten beskriver grav språkstörning och gränsdragningar mot andra tillstånd med påverkan på skolsituationen. Nationell och internationell forskning med relevans för skolsituationen för elever med språkstörning presenteras i avsnitt om språkutveckling, måluppfyllelse, skolplacering, psykosocial situation, flerspråkighet och samförekomst mellan språkstörning och andra utvecklingsrelaterade tillstånd. Språkstörning betecknar tillståndet hos de barn och ungdomar som uppvisar avvikande språkutveckling trots nödvändiga förutsättningar för språkinlärning (normal hörsel, typisk neurologisk och neurokognitiv utveckling och adekvat språklig stimulans). I riktlinjerna till den kliniska diagnosmanualen ICD-10 (WHO, 2007b) föreskrivs att barnets språkliga förmåga ska befinnas vara minst två standardavvikelser under den genomsnittliga för åldersgruppen medan barnets ickespråkliga förmåga får understiga den normala med högst en standardavvikelse. Vid diagnostisering ska beaktas (1) svårigheternas grad, (2) den språkliga utvecklingsgången, (3) språklig symptombild och (4) eventuell samförekomst med andra relaterade svårigheter (WHO, 1992:183). Diagnosdefinitionen har kritiserats för att såväl begränsa möjligheterna till insatser för de med störst behov, som att inte tillräckligt tydligt avgränsa den kliniska populationen, och efterlyses internationell konsensus kring en diagnosdefinition som tillgodoser såväl kliniska som forskningsrelaterade syften (Bishop, 2014; , Bishop & Tomblin, 2014; , Tomblin et al., 2014). I en debattartikel med förslag på ny definition av språkstörning sammanfattar , Bishop och Tomblin (2014) synpunkterna från forskare och kliniker världen över och förordar en bedömning av (1) språklig symptombild, (2) påverkan på individens aktivitet och delaktighet, (3) eventuell samförekomst med andra svårigheter och (4) den språkliga utvecklingsgången. Genom att inkludera aspekter av individens fungerande i det dagliga livet, vilket föreskrivs av internationella klassifikation av funktionstillstånd, funktionshinder och hälsa, ICF (WHO, 2001; WHO, 2007a), tillmäts individspecifika och kontextuellt betingade aspekter större diagnostisk betydelse. Detta perspektiv beskrivs också i kriterierna för språkstörning i diagnosmanualen för psykologisk och psykiatrisk vård, DSM-5 (DSM-5 Task Force, 2013; svensk version under bearbetning), som gör åtskillnad mellan diagnos och behov av insats. Synsättet överensstämmer med skolans skyldighet att tillhandahålla nödvändiga insatser för elever i behov av stöd oberoende av eventuell medicinsk diagnos (Skollag, 2010:800). Trots bristande diagnosdefinition är enigheten stor om vilka svårigheter språkstörning vållar samt hur dessa manifesteras och bör utredas.