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The impact of nonverbal ability on prevalence and clinical presentation of language disorder: Evidence from a population study
Journal of Child Psychology and Psychiatry
Abstract
Background:
Diagnosis of 'specific' language impairment traditionally required nonverbal IQ to be within normal limits, often resulting in restricted access to clinical services for children with lower NVIQ. Changes to DSM-5 criteria for language disorder removed this NVIQ requirement. This study sought to delineate the impact of varying NVIQ criteria on prevalence, clinical presentation and functional impact of language disorder in the first UK population study of language impairment at school entry.
Methods:
A population-based survey design with sample weighting procedures was used to estimate population prevalence. We surveyed state-maintained reception classrooms (n = 161 or 61% of eligible schools) in Surrey, England. From a total population of 12,398 children (ages 4-5 years), 7,267 (59%) were screened. A stratified subsample (n = 529) received comprehensive assessment of language, NVIQ, social, emotional and behavioural problems, and academic attainment.
Results:
The total population prevalence estimate of language disorder was 9.92% (95% CI 7.38, 13.20). The prevalence of language disorder of unknown origin was estimated to be 7.58% (95% CI 5.33, 10.66), while the prevalence of language impairment associated with intellectual disability and/or existing medical diagnosis was 2.34% (95% CI 1.40, 3.91). Children with language disorder displayed elevated symptoms of social, emotional and behavioural problems relative to peers, F(1, 466) = 7.88, p = .05, and 88% did not make expected academic progress. There were no differences between those with average and low-average NVIQ scores in severity of language deficit, social, emotional and behavioural problems, or educational attainment. In contrast, children with language impairments associated with known medical diagnosis and/or intellectual disability displayed more severe deficits on multiple measures.
Conclusions:
At school entry, approximately two children in every class of 30 pupils will experience language disorder severe enough to hinder academic progress. Access to specialist clinical services should not depend on NVIQ.
... According to prevalence studies, 7-16% of children are reported to have poor language development that cannot be explained by other developmental disorders, with scores falling more than 1.5 standard deviations below the mean of standard reference tests [7]. Additionally, 2.3% of children experience language issues as part of another neurodevelopmental disorder [8]. Data on the prevalence of language disorders in elementary school children indicate that boys are more significantly affected than girls [1,9]. ...
... Language difficulties often remain unresolved at the time of school entry, with vocabulary development during the preschool years continuing to influence language skills thereafter [10,11]. DLD affects approximately 7% of children at the time of school entry [8]. Evidence suggests that untreated language delays may persist in 40-60% of affected children, with these children being at higher risk for social, emotional, behavioral, and cognitive difficulties [12,13]. ...
... Estimates of the prevalence of DLD in English-speaking countries suggest that approximately 7% of children aged 4-5 years meet diagnostic criteria for the disorder, with a higher prevalence in males (57-59%) [8,21]. A potential decline in prevalence has been observed among children aged 7 to 9 years [11]. ...
Purpose: Elementary school is a crucial time for children’s language development as they acquire skills essential for learning. This study investigates the prevalence of speech and language development delays among early elementary school children in South Korea, providing insight into the speech and language development challenges faced by young students in the country.Methods: Ten speech-language pathologists conducted a screening test for speech and language disorders on a sample of 381 elementary school children aged 7 to 9 (boys 200, girls 181) from the Busan and Gwangju areas in Korea. They used the Receptive and Expressive Vocabulary Test (REVT) and the Urimal Test of Articulation and Phonology Test (UTAP).Results: Among the 381 children who underwent the test, 170 were identified as being at risk for having speech or language delay or disorders. This suggests that approximately 44.6% of the general population may exhibit speech or language problems. The prevalence of language delays was 35.6% for receptive vocabulary, 27.6% for expressive vocabulary, and 6.04% for speech delays. For boys, language delays were expected to range from 12.9% to 19.7%, while for girls, it was expected to be between 14.6% and 16.0%. In contrast, for articulation issues, 3.9% of boys and 2.1% of girls were found to have speech problems. Most of these children had not only language issues but also some speech disorders. Approximately 4.2% of the identified children had both speech and language problems, 38.6% had only language problems, and 1.8% had only speech problems.Conclusions: The high prevalence of language development delays among early elementary school children underscores the critical need for proactive language screening and intervention in the school environment.
... Different terms have been used to refer to LD over the years, such as developmental dysphasia, specific language impairment (SLI), and developmental language disorder (DLD; see Reilly et al., 2014, andBishop, 2014). LD poses a public health concern, as it is associated with an increased risk of school failure, poor employment outcomes, and behavioral, emotional, and social problems (Norbury et al., 2016;Tomblin et al., 2000). The estimated population prevalence of LD in the UK is 9.92%, with 7.58% attributed to an unknown origin (Norbury et al., 2016). ...
... LD poses a public health concern, as it is associated with an increased risk of school failure, poor employment outcomes, and behavioral, emotional, and social problems (Norbury et al., 2016;Tomblin et al., 2000). The estimated population prevalence of LD in the UK is 9.92%, with 7.58% attributed to an unknown origin (Norbury et al., 2016). Consequently, the study of LD is of great significance and has attracted increasing attention from researchers in various fields. ...
... Methodologies in the field of LD research encompass a diverse variety of approaches, including observational studies with longitudinal design (e.g., Conti-Ramsden et al., 2018;Norbury et al., 2017;Snowling et al., 2016), population-based design (e.g., Eadie et al., 2015;Norbury et al., 2016Norbury et al., , 2017, and experimental studies (e.g., Ehrhorn et al., 2021;Gathercole & Baddeley, 1990). Common assessment techniques include standardized language tests (e.g., Newcomer & Hammill, 2019), neuroimaging (e.g., Lee et al., 2013), and behavioral observations (e.g., Conti-Ramsden et al., 2013). ...
Language disorder (LD), as a public health concern, has received increasing attention from researchers. This study provides an overview of the knowledge domain of LD research and unveils the thematic patterns and emerging trends. A total of 8,649 articles on LD from 2003 to 2022 were collected from WoS and CiteSpace was employed for data analysis. The study focuses on temporal and geographic distribution, top journals, categories, authors, and co-citation analyses of references. The findings indicate that: (1) LD is of most concern in the fields of linguistics, rehabilitation, audiology and speech-language pathology, psychology, and neuroscience; (2) there is a dominance of the USA and England in LD publications; (3) the main thematic patterns include identification of language problems, neurogenetic mechanisms, diagnostic markers, cognitive mechanisms, auditory processing, and motor speech disorder; (4) the emerging trends include criteria and terminology for language problems, cognitive mechanisms, neurobiological factors, diagnostic markers, the population design, and longitudinal design. Future trends suggest a continued interdisciplinary approach into potential origins of LD, integrating new theoretical insights from linguistics, psychology, neuroscience and genetics, and this integration is enhanced by the application of digital technologies and artificial intelligence for improved diagnostic and therapeutic strategies. This scientometric analysis provides valuable insights into the evolving landscape of LD research, underscoring the need for more intense collaboration and further investigations in the field of LD.
... Language acquisition, the process enabling humans to communicate through language, represents a pivotal stage in child development. Language disorders are highly prevalent in children, with estimated rates ranging from 4 to 10%, varying by age and type of disorder [1][2][3]. These disorders, in their most severe and longlasting forms, have a significant impact on academic and professional performance throughout life. ...
... However, it has been acknowledged that DLD can co-occur with other conditions such as attention deficit hyperactivity disorder (ADHD), developmental dyslexia or coordination problems leading to a heterogeneous group of patients that encompasses a wide range of impairments. The prevalence of DLD is ~ 7-8% or 2% if severe forms are considered and the diagnosis is based on standardized language tests [2,5]. There is a continuum of severity ranging from speech delay to severe oral language structure disturbances in typically intelligent children. ...
Background
Developmental language disorder (DLD) refers to children who present with language difficulties that are not due to a known biomedical condition or associated with autism spectrum disorder (ASD) or intellectual disability (ID). The clinical heterogeneity of language disorders, the frequent presence of comorbidities, and the inconsistent terminology used over the years have impeded both research and clinical practice. Identifying sub-groups of children (i.e. DLD cases without childhood apraxia of speech (CAS)) with language difficulties is essential for elucidating the underlying genetic causes of this condition. DLD presents along a spectrum of severity, ranging from mild speech delays to profound disturbances in oral language structure in otherwise typically intelligent children. The prevalence of DLD is ~ 7-8% or 2% if severe forms are considered. This study aims to investigate a homogeneous cohort of DLD patients, excluding cases of ASD, ID or CAS, using multiple genomic approaches to better define the molecular basis of the disorder.
Methods
Fifteen families, including 27 children with severe DLD, were enrolled. The majority of cases (n = 24) were included in multiplex families while three cases were sporadic. This resulted in a cohort of 59 individuals for whom chromosomal microarray analysis and exome or genome sequencing were performed.
Results
We identified copy number variants (CNVs) predisposing to neurodevelopmental disorders with incomplete penetrance and variable expressivity in two families. These CNVs (i.e., 15q13.3 deletion and proximal 16p11.2 duplication) are interpreted as pathogenic. In one sporadic case, a de novo pathogenic variant in the ZNF292 gene, known to be associated with ID, was detected, broadening the spectrum of this syndrome.
Limitations
The strict diagnostic criteria applied by our multidisciplinary team, including speech-language physicians, neuropsychologists, and paediatric neurologists, resulted in a relatively small sample size, which limit the strength of our findings.
Conclusion
These findings highlight a common genetic architecture between DLD, ASD and ID, and underline the need for further investigation into overlapping neurodevelopmental pathways.
Trial registration
ClinicalTrials.gov Identifier: NCT06660108.
... Development language disorder (DLD) is a language disorder that arises during the developmental process and is not related to a recognized biomedical cause, such as intellectual disability, autism spectrum disorder (ASD), hearing loss, or genetic factors (Bishop et al. 2016(Bishop et al. , 2017. DLD is very common in early childhood (McGregor 2020;Norbury et al. 2016). Prevalence studies on DLD are reported to be around 1% to 7% (Calder et al. 2022;Norbury et al. 2016;Oyono, Pascoe, and Singh 2018;Tomblin et al. 1997). ...
... DLD is very common in early childhood (McGregor 2020;Norbury et al. 2016). Prevalence studies on DLD are reported to be around 1% to 7% (Calder et al. 2022;Norbury et al. 2016;Oyono, Pascoe, and Singh 2018;Tomblin et al. 1997). ...
Background
The aim was to compare the sensory processing skills of children diagnosed with developmental language disorder (DLD) with those of typically developing children and to investigate the relationship between language development and sensory processing skills.
Methods
The investigation comprised 60 children, all of whom were typically developing and diagnosed with DLD. The “Early Language Development‐Third: Turkish (ELD: Turkish)” and the “Sensory Profile (Caregiver Questionnaire)” were utilized to assess the language and sensory processing skills of the children, respectively, within the scope of the study.
Results
In our study, the four‐factor scores of children with DLD were considerably lower than those of their typically developing peers (p < 0.05). These factors are sensory seeking, inattention/distractibility, fine motor/perceptual, and emotionally reactive. In addition, the children with DLD had statistically significant lower scores in three quadrants except for sensory sensitivity (p < 0.05). In three quadrants (sensation seeking, low registration, and sensory avoiding) and three factors (sensory seeking, inattention/distractibility, and fine motor/perceptual), a substantial correlation was observed between the sensory processing skills and the language skills.
Conclusions
It has been observed that there are differences in the sensory processing skills of children with DLD. In addition to evaluating the language skills of these children, it will also contribute to the evaluation of the effectiveness of their sensory processing skills and the development of more effective strategies in the intervention processes of these children.
... Similarly, DLD is associated with non-linguistic limitations that may reflect general cognitive difficulties (Bishop et al., 2017;Larson et al., 2020;Norbury et al., 2016). Evidence in Spanishspeaking subjects, such as that presented by Quintero et al., (2013), suggests impairments in core functions essential for language development. ...
... An important aspect of diagnosis, which was not addressed by the participants, pertains to the non-linguistic issues of children with DLD (Aguado et al., 2015;Andreu et al., 2021;Bishop et al., 2017;Larson et al., 2020;Norbury et al., 2016). Research indicates the importance of assessing other cognitive skills such as attention and memory, which are often affected in children with DLD. ...
Developmental Language Disorder (DLD) is increasingly prevalent in childhood. In this context, the perception of therapists and education professionals is crucial to improving clinical and educational practices related to its treatment. This qualitative phenomenographic study addresses the personal experiences, perceptions, and practices of therapists and education professionals in charge of treating DLD within educational settings in Chile through semi-structured interviews. The sample includes ten professionals with experience working in schools dedicated to language therapy and schools with Programa de Integracion Escolar(School Integration Program) in the south of the country. The content of the interviews was subject to thematic analysis, which yielded three central themes: the heterogeneity of DLD, perceptions of the experience of working with children, and therapeuticand educational interventions' structure. This research highlights the diversity of approaches and challenges professionals face in treating DLD. The results reflect a need for consensus to improve the terminology, classification criteria, and assessments in this area, with limitations that point to future research that expands the sampleand includes other Spanish-speaking contexts. This study has significant projections for updating interventions and standardizing assessment instruments for DLD.
... Za podstawowy wyznacznik SLI/DLD uznaje się zaburzenia lingwistyczne przy znacznie lepszym poziomie umiejętności niejęzykowych, chociaż i one wedle najnowszych badań zespołu Courtenay F. Norbury (2016) znajdują się na poziomie poniżej normy rozwojowej. Jeśli chodzi o kryteria włączające i wyłączające diagnozę SLI/DLD, to wytyczne zawarte w ICD-10 1 , DSM-5 (Morrison 2016) nie są zbieżne. ...
... Brak zasadności utrzymywania tezy o dysproporcji w zakresie IQ werbalnego i niewerbalnego u dzieci z SLI/DLD potwierdza swoimi badaniami także zespół Courtenay F. Norbury (2016Norbury ( : 1254Norbury ( -1255. Jej zdaniem nasilenie deficytów językowych, problemów społecznych, emocjonalnych, behawioralnych, a także osiągnięć szkolnych nie koreluje z przeciętnymi wynikami w zakresie niewerbalnego IQ ani z wynikami poniżej przeciętnej, w związku z czym dostęp do świadczeń medycznych i terapeutycznych nie powinien zależeć od poziomu niewerbalnego IQ. ...
Artykuł jest poświęcony zależnościom między afazją i zespołem Aspergera, które w ujęciu tradycyjnych taksonomii należą do odrębnych zaburzeń neurorozwojowych, wpływających na zdolności językowe oraz komunikacyjne dzieci. Przedmiot artykułu stanowi ocena możliwości współwystępowania specyficznych zaburzeń językowych (SLI/DLD) oraz zespołu Aspergera u tej samej jednostki, co tym samym potwierdza zasadność prowadzenia diagnozy dymensjonalnej. Autorki dokonują przeglądu literatury, omawiają kryteria włączające i wyłączające diagnozę SLI/DLD oraz ZA, a także uwikłanej pomiędzy nimi jednostki o nazwie deficyt semantyczno-pragmatyczny w nawiązaniu do klasyfikacji ICD, DSM oraz najnowszych ustaleń opublikowanych w literaturze przedmiotu. Prezentują dwa spojrzenia badaczy na ewentualną możliwość nakładania się wspomnianych deficytów, wskazując na dane z badań porównujących umiejętności językowe, a także genetyczne aspekty ich ewentualnego nakładania się.
... In a recent study in China, the prevalence of language disorders in children was 8.5% [11]. This number was equal to 7.6% in England [12]. ...
... It has significant and long-lasting impacts on personal growth. Some studies in the UK and China showed that about 7.6% and 8.5% of children aged 3 to 5 have developmental language disorder [11,12]. This is more common than autism spectrum disorder (which affects 1.86% of children) and attention-deficit/hyperactivity disorder (ADHD, which affects 5% of children). ...
Background
Mental health issues in adulthood often start in childhood, so it’s important to identify these issues early and find ways to manage them. To our knowledge, no study was found that evaluated the long-term effects of language nursing intervention on mental health in children with poor language skills. This study, therefore, aimed to evaluate the long-term impact of a language nursing intervention on the mental health of children with poor language skills.
Methods
We estimated poor language skills prevalence in 3-4-year-old children who were planning to enter kindergartens in Hunan, China. After selecting these children, we divided them into two experimental and control groups. The experimental group received a nursing intervention related to language skills for eight months. After eight months, the language skills of both groups were re-evaluated. Then, in the follow-up evaluation, the mental health of these children was evaluated at the ages of 9–10 years. Univariate and multivariate regression models adjusted with sampling weights were used to estimate the correlation of mental health and risk factors.
Results
The language skills of the experimental group increased significantly compared to before the protocol (from 87.4±10.87 to 98.08±7.13; p = 0.001). At the end of the eight-month nursing intervention, the language skills of the experimental group were significantly higher than the control group (98.08±7.13 in experimental group and 87.51±9.59 in control group; p = 0.001). In multivariate analysis, single-parent family and not participating in the nursing protocol related to language skills at the age of 3–4 years were related to high symptoms of depression, anxiety and stress symptoms (single-parent family: for depression symptoms, OR = 1.28, 95% CI = 0.88–1.42; for stress symptoms, OR = 1.31, 95% CI = 0.79–2.74 and for anxiety symptoms, OR = 1.42, 95% CI = 0.97–2.44; not participating in the nursing protocol related to language skills at the age of 3–4 years: for depression symptoms, OR = 2.98, 95% CI = 1.80–5.19; for stress symptoms, OR = 1.88, 95% CI = 1.23–2.01 and for anxiety symptoms, OR = 2.67, 95% CI = 1.51–3.77; p<0.05).
Conclusion
The current study showed the effectiveness of this intervention on both language skills and mental health of children with poor language skills.
... With a prevalence of approx. 10%, they are one of the most common developmental disorders in childhood [9,10]. For the majority of children, their language disorder is of unknown origin, i.e., not associated with a known differentiating condition (e.g., a genetic syndrome) with deficits appearing mainly in the language domain. ...
Background/Objectives: Developmental language disorders (DLD) are often associated with co-occurring neurodevelopmental difficulties, including attentional or social–emotional problems. Another nonverbal domain, i.e., visual cognition and its relationship to DLD, is virtually unexplored. However, learning visuospatial regularities – a scene-grammar - is crucial for navigating our daily environment. These regularities show certain similarities to the structure of language and there is preliminary evidence for a relationship between scene processing and language competence in preschoolers with and without DLD. This study compared implicit and explicit visuospatial knowledge of everyday indoor scenes in older children, aged 6 to 10 years, of both groups. Methods: We measured ‘dwell times’ on semantic and syntactic object – scene inconsistencies via eye-tracking and performance in an object-placement task, and their associations with children’s language, visual, and cognitive skills. Results: Visual attention towards object-scene inconsistencies was highly comparable between groups, but children with DLD scored lower in a visual perception test and higher language skills were associated with higher visuo-cognitive performance in both tasks. In the explicit scene-grammar measurement, this relationship only existed for children with DLD and disappeared when nonverbal cognitive performance was controlled. Conclusions: Our study suggests the existence of mild problems in visuospatial processing co-occurring with DLD, which is partly influenced by age and nonverbal cognitive ability. The acquisition of visual cognition and linguistic knowledge is an interactive, multimodal process where the perception of objects in scenes might affect how the words for these objects are learned and vice versa. A better understanding of this interplay could eventually have impact on the diagnosis and treatment of DLD.
... In the general population, around 1 in 4 school-age children experience difficulties with language, literacy, and/or learning [13][14][15][16][17]. Approximately 15% of children live with clinical levels of language and/or specific learning difficulties such as developmental language disorder and development dyslexia [18]. In addition, many children in Australia are learning are learning to speak English as a second or additional language [19,20]. ...
Objective: This review will map existing literature to identify and describe the extent to which Universal Design for Learning (UDL) principles of engagement, representation, and expression are applied to the design, delivery, and/or evaluation of school-based mental health programs in Australia. Introduction: UDL is an education framework that aims to create inclusive learning environments for students with diverse needs. Approximately 25% of Australian students are likely to live with language, literacy, and/or learning differences that place them at elevated risk of mental health problems. Many school-based mental health programs exist with the shared aim of promoting positive outcomes for students. Early prevention and mental health promotion efforts that are inclusive to students with language and/or learning differences are critically important. However, there has been no previous exploration of the extent to which UDL has been applied to school-based mental health programs. This review aims to identify and describe the extent to which UDL principles are evident in existing Australian school-based mental health programs. Eligibility criteria: This review will consider studies that report the development and/or evaluation of school-based mental health programs within an Australian education context. This review will exclude non-English studies, reviews, books, and theoretical or opinion pieces. Methods: This review will be informed by the JBI guidelines for scoping reviews and will be conducted between October and December 2024. Five databases will be searched (PsycInfo, Medline, Informit, Scopus, and ERIC) and two reviewers will independently screen all identified studies against inclusion criteria by title, abstract, and full text review. Conflicts will be resolved by consensus. Results: Two independent reviewers will extract relevant data from the selected studies and results will be presented numerically and narratively. The review will identify and describe the extent to which UDL principles are evident in descriptions of the design, delivery, and/or evaluation of school-based mental health programs in Australia. Synthesis and interpretation of included studies will be framed within the three principles of UDL. The review will outline key findings of the included papers, gaps in the literature, and salient directions for future research. Conclusion: The outcomes of this review will be disseminated via publication and plain language summaries. The outcomes may also inform conference presentations relevant to inclusive education, mental health, and child language and learning differences.
... Approximately 6-8% of all school-aged children have a developmental language disorder, which influences all aspects of academic learning and social participation (Calder et al., 2022;Norbury et al., 2016). Of these, about 1% need AAC to communicate due to their speech being unintelligible (Binger et al., 2021). ...
Augmentative and alternative communication Students' questions CARM A B S T R A C T This study investigates the effect of communication skills training concerning aided-speaking students' questions in classroom interaction. Eighty-two Swedish teachers and classroom assistants working with students using augmentative and alternative communication (AAC) participated. The study was based on the Conversation Analytic Role-play Method (CARM) and implemented as a pre-post intervention design. The results show significant change on self-efficacy but not on interactional awareness. Level of education in combination with firsthand contact with students was significant. The correlation between self-efficacy and interactional awareness indicated interdependency. The study highlights how AAC topics can be included in teacher education and communication skills training for professionals.
... Neurodevelopmental disorders (NDDs) are a group of conditions that emerge during the early developmental period (APA, 2016). While prevalence rates vary and there are high comorbidities between disorders, the most common NDDs include developmental language disorder ([DLD], 7%; Norbury et al., 2016), attention deficit-hyperactivity disorder ([ADHD], 5-11%), autism spectrum disorder ([ASD], 0.70-3%), specific learning disorders ([SLDs], 3-10%), and motor disorders (0.76-17%; Franc es et al., 2022). Among young people with NDDs, rates of mental health problemsincluding internalising (e.g. ...
... Zubrick et al., 2007). Many LTs go on to reach expectations set for their TD peers, although for some, this may not be until they are 5 years old, and up to 40% of LTs will not potentially going on to receive a diagnosis of DLD (e.g., Bates et al., 1995;Bishop, 2017;Norbury et al., 2016;Rescorla, 2011). At first, those children who do appear to catch up were believed to resume a typical developmental trajectory. ...
Purpose
Prior work has found that “late talkers” (LTs) as a group continue to demonstrate lower language and reading outcomes compared to their typically developing (TD) peers even into young adulthood. Others identified that children diagnosed with developmental language disorder (DLD) show difficulties later with theory of mind (ToM) tasks and metaphor comprehension, but there is a shortage of research specifically investigating these advanced skills in LTs. The current study therefore compared language-related skills of former LTs with their TD peers at school age.
Method
A longitudinal sample (N = 35) of monolingual German-speaking children was observed from age 1 until 9, comprising TD children (n = 27) and children identified as LTs at age 2 (n = 8), of which two met criteria for DLD between ages 3 and 6. Children's language (productive vocabulary, productive and receptive grammar), reading, metaphor comprehension, and ToM skills (ToM scale and Strange Stories) were investigated, and group comparisons were conducted.
Results
Former LTs performed worse than the TD children on measures of productive vocabulary, receptive grammar, metaphor comprehension, and the ToM Strange Stories task at the age of 9, but not on measures of productive grammar, reading, or the ToM scale.
Conclusions
The findings indicate that LTs can catch up with their TD peers in some areas of language and ToM but that subtle differences remain across other complex areas. Further research is needed to pinpoint possible explanations for why certain skills are more strongly impacted and the potential developmental interactions between these competencies.
... Information related to development in children with CP ± L and speech and language development in general was also collected to be included as potential confounders in data analysis. This comprised: cleft type, structurally related speech difficulties/history of speech surgery (Butterworth et al., 2023), gender (Norbury et al., 2016), socio-economic status (Reilly et al., 2007), family history of speech and language difficulties (Eadie et al., 2015), non-verbal skills (Wetherell et al., 2007) and history of hearing difficulties (Schönweiler et al., 1998). Details of how confounding variables were measured are given in Table 1. ...
Background
Children born with cleft palate ± lip (CP ± L) are at risk of speech sound disorder (SSD). Up to 40% continue to have SSD at age 5–6 years. These difficulties are typically described as articulatory in nature and often include cleft speech characteristics (CSC) hypothesized to result from structural differences. In non‐CP ± L SSD comorbidity with language difficulties is often reported. There is growing evidence of concomitant language difficulties in children with CP ± L and of a higher prevalence of developmental speech errors in children compared with non‐CP ± L peers. The impact of underlying phonological and language skills on speech production in children with CP ± L is poorly understood.
Aims
To investigate language outcomes in children with CP ± L and the relationship to speech production, by answering the following research questions: (1) Does the profile of language skills in children with CP ± L differ from normative samples? (2) Do children with CP ± L and SSD have poorer language skills than those with typically developing speech? (3) Is there an association between language skills and speech profile in children with CP ± L at age 5–8 years?
Methods & Procedures
In this prospective cross‐sectional, observational study, 95 participants were recruited from regional cleft lip and palate services in the UK. They were aged 5;0–7;11 with non‐syndromic CP ± L. Those with a syndromic diagnosis, global learning disability, sensorineural hearing loss and first language other than English were excluded. Assessments of speech (Diagnostic Evaluation of Articulation and Phonology—DEAP) and language (Clinical Evaluation of Language Fundamentals—5th UK edition—CELF) were completed. Language outcomes were analysed and compared with normative samples and according to speech error analysis.
Outcomes & Results
Average language scores were within the expected range. For those presenting with SSD, language scores were significantly lower than those with typically developing speech. Analysis of speech errors showed four distinct speech profiles: typical speech, CSC only, developmental speech characteristics (DSC), and combined CSC + DSC. Language scores were lower for participants with DSC (±CSC). A significant association was found between the presence of CSC + DSC and expressive language outcomes (odds ratio (OR) = 10.82; 95% confidence interval (CI) = 2.42, 48.32, p = 0.002).
Conclusions & Implications
An association between language skills and speech production was observed. The distribution of speech errors in children with CP ± L varied with a high level of DSC as well as CSC. Those with CSC + DSC had significantly lower language scores than those with typically developing speech or CSC only. Speech and language therapists working with this caseload should be alerted to potential ongoing phonological and language difficulties in children presenting with this profile.
WHAT THIS PAPER ADDS
What is already known on this subject
Children born with CP ± L are known to be at risk of SSD. There is also evidence of language delay in the early years. Evidence for persistent language difficulties is equivocal but some studies have shown a higher than average prevalence of developmental phonological errors in addition to cleft articulation errors in speech production.
What this paper adds to the existing knowledge
This study investigates links between speech development and language skills in children aged 5–8 years with non‐syndromic CP ± L. It adds to our understanding of the nature of SSD in children with CP ± L and in particular the relationship between language skills and speech production. It shows that children with CP ± L have varied speech profiles and that those presenting with delayed phonological processes are also at risk of language difficulties.
What are the potential or actual clinical implications of this work?
Speech and language therapists working with children with CP ± L should be aware of the varied nature of SSD in this population. They should be alert to the need for additional assessment of language for those presenting with delayed phonological processes and the implications this has for educational attainment.
This paper is open access please follow this link to obtain a full, peer reviewed copy: https://onlinelibrary.wiley.com/doi/full/10.1111/1460-6984.13151
... The relation between language and social competence may vary based on child sex at birth. In general, girls may have a language advantage relative to boys, given that girls tend to show stronger language skills in earlier childhood (Bornstein, Hahn, and Haynes 2004;Rice and Hoffman 2015) and that boys show higher prevalence rates of clinical language difficulties (e.g., Chilosi et al. 2021;Norbury et al. 2016). Some literature also suggests that girls tend to present as more prosocial compared to boys (e.g., McTaggart, McGill, and Stephens 2022). ...
Research examining relations between language skills and social competence has yielded mixed findings. Three meta‐analyses investigated links between language skills (overall, receptive, and expressive) and social competence in 2‐ to 12‐year‐old children. Data from 130 studies representing 62,120 children (M age at language assessment = 4.70 years; 52% male), predominantly from North America and Europe, and identifying as White (33%), Black (17%), Hispanic (14%), Asian (2%), Mixed (4%), Indigenous (1%), and Other/Unspecified (29%) were analyzed. Analyses indicated significant medium‐sized associations between social competence and: overall language ( r = 0.27), receptive language ( r = 0.23), and expressive language ( r = 0.20). Exploratory analyses indicated significant moderating effects of study design, publication status, social type, and geographic region. Results and implications are discussed.
... Developmental language disorder (DLD) is a highly prevalent (Bishop et al., 2017;Norbury et al., 2016) and lifelong neurodevelopmental condition (Botting, 2020;McGregor, 2020;Nippold & Schwarz, 2002;Tomblin et al., 1992;Whitehouse et al., 2009). It is associated with poorer long-term academic, vocational, and social-emotional outcomes than neurotypical (NT) peers Conti-Ramsden et al., 2013;Durkin et al., 2012Durkin et al., , 2015Le et al., 2021;Records et al., 1992;Whitehouse et al., 2009;Ziegenfusz et al., 2022). ...
Purpose
Developmental language disorder (DLD) is a lifelong condition associated with poorer outcomes than neurotypical peers, yet relatively little is known about long-term quality of life in DLD. This preliminary study adopts a neurodiversity-informed approach by exploring self-reported quality of life in an adolescent and young adult DLD sample, as well as linguistic and risk factors contributing to quality of life.
Method
Participants were five individuals with DLD aged 12–20 years (M = 15.60, SD = 3.05). I administered two self-report quality-of-life scales, a language assessment, an experimental morphosyntax task, and measures of risk factors. Data were analyzed descriptively.
Results
Participants generally reported positive views about their quality of life, although accessing accommodations and health services emerged as barriers. Relatively better grammaticality judgment performance appeared to be linked with poorer ratings of happiness and the ability to “be yourself.” Nonverbal ability represented a potential risk factor, although there may be a stronger cumulative role for risk factors.
Conclusions
Participants with DLD reported relatively good quality of life. Exploratory findings suggest barriers to quality of life in some contexts, as well as roles for individual differences in language and risk factors. These descriptive findings should be examined in larger scale studies and may represent areas of consideration when clinicians address functional challenges that impact mental health and well-being in individuals with DLD.
Supplemental Material
https://doi.org/10.23641/asha.27997529
... V. M. Bishop et al., 2017). Up to 8% of children meet the criteria for DLD depending on the population and definition of impairment (Law et al., 2000;Norbury et al., 2016;Tomblin et al., 1997;Weindrich et al., 2000). Language impairments in DLD are not caused by articulation issues; rather, they are associated with problems producing and comprehending the various components of language itself (e.g., phonology, syntax, semantics). ...
Purpose
Recent advances in artificial intelligence provide opportunities to capture and represent complex features of human language in a more automated manner, offering potential means of improving the efficiency of language assessment. This review article presents computerized approaches for the analysis of narrative language and identification of language disorders in children.
Method
We first describe the current barriers to clinicians' use of language sample analysis, narrative language sampling approaches, and the data processing stages that precede analysis. We then present recent studies demonstrating the automated extraction of linguistic features and identification of developmental language disorder using natural language processing and machine learning. We explain how these tools operate and emphasize how the decisions made in construction impact their performance in important ways, especially in the analysis of child language samples. We conclude with a discussion of major challenges in the field with respect to bias, access, and generalizability across settings and applications.
Conclusion
Given the progress that has occurred over the last decade, computer-automated approaches offer a promising opportunity to improve the efficiency and accessibility of language sample analysis and expedite the diagnosis and treatment of language disorders in children.
... The disorders below are not confined to childhood but affect many during adulthood. Some studies indicate that only 40-50% of children with language disorders experience language and communication difficulties in their adolescent and adult lives (Norbury et al., 2016). To this extent, this emphasizes the complications of childhood language disorders and their ramifications regarding academic, social, and vocational victories. ...
Language disorders are considered a substantial neurodevelopmental disability, within which 7- 10% of children of the global population are affected by different forms of language disorders. These disorders are defined by impairment of language understanding and production, showing lifelong impacts on cognition, learning, communication and social interaction. These questions include: what are the causes of language disorders, how is language disorder diagnosed, and what are the best practices when treating a person with language disorder? This research uses a mixed-method research design based on theoretical foundations such as the biopsychosocial model, the Neurocognitive Developmental Model by Paula Raja and the Social Interactionism model by Uzer Kaya. A bibliography review was conducted, supplemented by using standardized language tests, neuropsychological examinations, and case reports to study the frequency and cognitive effects of linguistic impairments. These research findings show that language disorders are directly related to severe attention and memory problems, and the structural differences in the brain are identifiable. Furthermore, these disorders come with social and emotional impacts since the patient suffers from anxiety, depression, or poor academic performance. Dynamic assessment and context-based student and context-specific early intervention can effectively reduce these impacts. Applying evidence-based learning across individual learning underscores the need to incorporate cognitive and social factors while teaching language disorders, which is key to the study. This study supports the intervention of multiple disciplines and early detection to improve language and quality of life in affected people.
... Za RJP je karakteristično da su djetetove jezične sposobnosti značajno ispod razine očekivane s obzirom na below the level expected for their age, but these language deficits cannot be explained by other neurodevelopmental disorders, neurological conditions, brain injuries, intellectual disability, sensory and motoric deficits, or other medical factors known to cause language impairment (Bishop, 2006;Leonard, 2014). Although it was previously assumed that all other cognitive functions of children with DLD were normal, more recent data suggest that children with DLD can perform worse on non-verbal cognitive tasks than their typically developing peers (e.g., Bishop et al., 2016;Gallinat & Spaulding, 2014;Norbury et al., 2016;Ralli et al., 2021). ...
Prethodna istraživanja pokazala su da su uzročne atribucije, odnosno zaključci koje ljudi donose o uzrocima nekog ishoda (Hewstone i Fincham, 2001), povezane s prilagodbom roditelja na djetetovu bolest ili razvojne poremećaje, no rezultati nisu jednoznačni. Provedeno istraživanje imalo je dva cilja: 1) opisati kojim uzrocima roditelji objašnjavaju razvojni jezični poremećaj (RJP) kod svoga djeteta i kako te uzroke procjenjuju na dimenzijama mjesta uzročnosti, podložnosti osobnoj kontroli i stabilnosti te 2) ispitati odnos atribucija uzroka djetetovog RJP-a i mentalnog zdravlja roditelja te provjeriti razlikuju li se odnosi ovisno o vremenu koje je prošlo od dijagnoze. U istraživanju je sudjelovalo 319 bioloških roditelja (94.2 % majki, prosječne dobi M = 39.71 godina, SD = 5.09) čijoj je djeci dijagnosticiran RJP kao primarna dijagnoza. Sudionici su ispunili online anketni upitnik koji se sastojao od demografskih pitanja, Revidirane skale uzročnih dimenzija (CDS-II; McAuley i sur., 1992) i Skale depresivnosti, anksioznosti i stresa (DASS-21; Lovibond i Lovibond, 1995). Rezultati su pokazali da roditelji djetetov RJP u najvećoj mjeri pripisuju genetskim čimbenicima te različitim prenatalnim i perinatalnim rizičnim čimbenicima. Za sve kategorije uzroka mjesto uzročnosti u prosjeku su procjenjivali vanjskim. Izloženost ekranima te neadekvatan jezični unos i reakcije roditelja procijenjeni su kao uzroci koji su najpodložniji osobnoj kontroli, a najstabilnijima su procijenjeni genetski čimbenici. Provedbom linearnog strukturalnog modeliranja dobiveni su značajni učinci percipiranog mjesta uzročnosti i podložnosti uzroka osobnoj kontroli na negativna emocionalna stanja roditelja, ali samo na nižim razinama vremena proteklog od djetetove dijagnoze, pri čemu je za mjesto uzročnosti dobiven negativan učinak, a za osobnu kontrolu pozitivan. Za percipiranu stabilnost uzroka djetetova poremećaja dobiven je pozitivan učinak koji je bio značajan i na višim razinama vremena proteklog od postavljanja djetetove dijagnoze. Raspravljene su teorijske i praktične implikacije dobivenih rezultata.
... Although children with DLD do not exhibit noticeable intellectual disabilities, hearing loss, or other medical conditions or syndromes that typically cause language disorders, they still face challenges in acquiring both spoken and written language skills, including expression and comprehension [1]. The prevalence of DLD is estimated to be between 7% and 11% [2], [3]. These difficulties can hinder children's language communication to varying degrees, significantly impacting their quality of life, social interactions, educational attainment, and future employment opportunities. ...
Developmental language disorder (DLD) presents significant clinical challenges and has lasting impacts on children. This study aims to develop a classification model for young children with DLD based on their brain function signals. Children aged 3.0 to 7.0 years participated in this study, including 21 children with DLD and 43 controls. All participants completed functional near-infrared spectroscopy (fNIRS) tasks designed to assess word expression ability (report task) and word comprehension ability (point task). General linear model (GLM) analysis was conducted to compare activation differences across fNIRS channels between the two groups. For DLD classification, a one-dimensional Convolutional Neural Network (CNN) was applied to hemoglobin oxygenation (HbO) signals from three regions of interest (ROIs), which included the bilateral inferior frontal gyrus (encompassing Broca's area), the bilateral temporo-parietal junction (encompassing Wernicke's area), and the bilateral motor cortex. Using HbO signal features the bilateral inferior frontal gyrus during the word expression task, the CNN model achieved a validation F1 score of 72.89%. Similarly, using HbO signal features from from the bilateral temporo-parietal junction during the word comprehension task, the CNN model achieved a validation F1 score of 71.81%. Additionally, children with DLD showed atypical activation in the right temporo-parietal junction area and left inferior frontal gyrus during both tasks. Our findings demonstrate that brain signals recorded during language tasks can effectively differentiate young children with DLD, highlighting the potential of task-based fNIRS as a valuable adjunct in the clinical diagnosis of DLD.
... 6 The current study contains a higher proportion of children with LLDs than would be expected from random sampling. The prevalence of DLD is approximately 7.5% (Norbury et al., 2016;Tomblin et al., 1997); prevalence estimates of dyslexia range from 3% to 20% (Adlof & Hogan, 2018). The high proportion of children with DLD in the current study could have resulted from recruitment strategies. ...
Purpose
This study examined science achievement; science vocabulary knowledge; and the relationship between science vocabulary, language skills, and science achievement in school-age children with language/literacy disorders (LLDs) and typical language development (TD).
Method
Thirty-nine sixth graders (11 with LLDs) completed standardized assessments and researcher-designed science vocabulary measures over Zoom. Scores for the AIMS Science, a standardized science assessment administered to all fourth-grade public-school students in Arizona, served as the outcome measure for science achievement. Linear regression analyses were performed to examine the relationships among science achievement, general language skills, and science vocabulary knowledge. Group comparisons (TD vs. LLD) were also completed for science achievement and science vocabulary measures.
Results
General language skills, science vocabulary breadth, and science vocabulary definition scores uniquely predicted science achievement, as measured by AIMS Science scores. General language skills predicted performance on the science vocabulary breadth and definition tasks. Participants with LLDs scored significantly lower on science achievement and vocabulary measures relative to their peers with TD.
Conclusions
Students with LLDs demonstrated poorer science achievement outcomes and more limited knowledge of science vocabulary breadth and semantic depth. Greater science vocabulary knowledge was associated with higher science test scores for children with LLDs and TD. These findings indicate that increasing science vocabulary knowledge may improve science achievement outcomes for students with LLDs or TD.
... Developmental language disorder (DLD) is a neurodevelopmental communication-affecting disorder impacting the language-processing regions of the human brain (Lee et al., 2020). This condition has a notable impact on a considerable percentage of the global child population, estimated at 7.58% (Norbury et al., 2016). Children with DLD experience difficulties in the perception and production of language structures as shown by numerous studies. ...
Children with developmental language disorder (DLD) encounter difficulties in acquiring various language structures. Early identification and intervention are crucial to prevent negative long-term outcomes impacting the academic, social, and emotional development of children. The study aims to develop an automated method for the identification of DLD using artificial intelligence, specifically a neural network machine learning algorithm. This protocol is applied for the first time in a Cypriot Greek child population with DLD. The neural network model was trained using perceptual and production data elicited from 15 children with DLD and 15 healthy controls in the age range of 7;10–10;4. The k-fold technique was used to cross-validate the algorithm. The performance of the model was evaluated using metrics, such as accuracy, precision, recall, F1-score, and ROC curve/AUC to assess its ability to make accurate predictions on a set of unseen data. The results demonstrated high classification values for all metrics, indicating the high accuracy of the neural model in classifying children with DLD. Furthermore, a variable importance analysis revealed that the language production skills of children had a more significant impact on the performance of the model compared to perception skills. Machine learning paradigms provide effective discrimination between children with DLD and those with TD, with the potential to enhance clinical assessment and facilitate earlier and more efficient detection of the disorder.
... Approximately 7% of people have DLD (Calder et al., 2022;Norbury et al., 2016), which is defined as language difficulties impacting everyday functioning that cannot be attributed to any specific condition or environmental factor. Individuals with DLD have higher rates than the general population of difficulties with reading, attention, verbal learning and memory, although it is a heterogeneous condition and all individuals have different relative strengths and difficulties (Bishop et al., 2017). ...
Background
Eighty‐five percent of medical research goes to waste, partly because it is not appropriately communicated to stakeholders. This represents a critical issue for the research community, especially because individuals who are impacted by research should be able to readily access that research. Making research findings accessible to key stakeholders is an important step in implementation science and in enabling research to have meaningful impacts. Plain language summaries are a tool to make research more accessible to individuals with communication disorders. While guidelines exist to support researchers to develop plain language summaries for some populations, no such guidelines exist for the developmental language disorder (DLD) community.
Aims
We aimed to develop evidence‐informed guidelines to support researchers to create plain language summaries that are accessible for individuals with DLD, their families, and the broader community. This discussion paper describes the development of these guidelines and how they may be implemented by researchers who conduct research on the topic of DLD.
Methods
We drew from existing plain language summary guidelines for other populations and knowledge of various barriers that may impact the DLD community's ability to access scientific research. We used this knowledge to create guidelines for researchers to develop plain language summaries of their research relating to the DLD population. This includes guidelines for creating written, visual, audio and video summaries. We consulted with an adult with DLD, an implementation scientist, and a speech‐language pathologist regarding the suitability of the guidelines.
Main Contribution
The plain language summary guidelines are publicly available via https://osf.io/ydkw9 . They include templates and examples, as well as suggestions for writing and visual styles. We encourage strengths‐based language, seeking feedback from non‐experts, and sharing the summaries on social media. We have also developed an online repository for researchers to disseminate their plain language summaries via DLD advocacy groups.
Conclusions
The written, audio and video plain language summaries that researchers create using our guidelines can be used to disseminate research to the DLD community. This can facilitate science implementation and maximise the impact of DLD research. The plain language summaries may also help individuals with DLD better understand the research that has been conducted about them. This may in turn support their engagement with services and empower them to make evidence‐informed choices for themselves and partner in co‐designing new research. Future research could explore the perspectives of the DLD community and researchers regarding the implementation of these guidelines.
... These difficulties are not due to intellectual disability, hearing impairment, neurological impairment, or other known biomedical conditions that may limit language function. Instead, it arises during early development from a complex and still poorly understood combination of genetic and environmental factors (Mountford et al., 2022), with an estimated prevalence of 7.58% at preschool age (Norbury et al., 2016). The importance of a multidisciplinary differential diagnosis is emphasised, as DLD may share symptoms (e.g. in terms of pragmatic skills such as turn-taking or maintaining topic focus) with other disorders, such as social-pragmatic communication disorders, autism spectrum disorder, or attention deficit hyperactivity disorder (ADHD) (Simms & Jin, 2015). ...
This study aims to investigate the linguistic organisation and coherence of personal narratives among children with Developmental Language Disorder (DLD) to provide insight into their communication skills in everyday contexts. A cohort of 10-year-old Croatian-speaking children diagnosed with DLD (n = 50, M = 10;8) and their gender-matched typically developing peers (TLD; n = 50, M = 10;2) participated in the study. All participants were asked to produce personal narratives in response to the Global TALES protocol, a standard protocol in which the child is asked to tell personal stories in response to six emotion- and situation-based prompts. Their responses were analysed at micro- and macro-structure levels on measures of vocabulary, grammar, productivity and coherence. Findings indicate that children with DLD have difficulties in both grammatical aspects of narrative production (complexity and accuracy) and the formation of coherent personal narratives, characterised by difficulties in creating chronologically organised and thematically elaborated narratives. Moreover, narrative measures, particularly those pertaining to grammar, demonstrate sensitivity in accurately predicting group membership, distinguishing between children with DLD and their TLD peers.
... Developmental language disorder (DLD) is a lifelong, neurodevelopmental condition related to difficulties with understanding and/or using language, which significantly impacts the person's functioning in daily life and cannot be explained by a biomedical condition (Bishop et al., 2016(Bishop et al., , 2017. It affects approximately 7% of the population (Bishop et al., 2017;Norbury et al., 2016), yet public awareness of DLD is low (Kim et al., 2022). Many students with DLD experience lower academic achievement than their peers (Conti-Ramsden et al., 2009;Ziegenfusz et al., 2022), emphasizing the need for support to access the curriculum (Gallagher et al., 2019). ...
Background & Aims
Students with developmental language disorder (DLD) often experience academic underachievement, and require adjustments and accommodations to access the curriculum. Teachers, allied health professionals and parents/caregivers have varying roles in the education process, and it is essential they work together to provide optimal support. However, their perspectives on the areas of functioning most impacting learning, the difficulty of school‐based tasks and the helpfulness of educational support have received limited attention.
Methods & Procedures
A between‐group survey design was used with recruitment occurring from September 2020 to October 2021. A total of 293 participants was comprised of teachers ( n = 78), allied health professionals ( n = 138) and parents/caregivers ( n = 77). All respondents rated the learning impact of seven areas of functioning (academic behaviour, fine/gross motor, language/communication, literacy, numeracy, sensory and social/emotional), the difficulty of 39 school‐based tasks, and the helpfulness of 27 educational supports for primary and/or secondary school‐aged students with DLD. The groups of school‐based tasks were combined into seven subscales (academic behaviour‐related tasks, fine/gross motor tasks, language/communication tasks, literacy tasks, numeracy tasks, sensory‐related tasks and social/emotional tasks) for analysis. The educational supports were also combined into six subscales (additional time, differentiation/adjustments, individualized support, social/emotional support, technology and visual supports).
Outcomes & Results
All participants rated literacy and language/communication as the areas of functioning most impacting learning and requiring the highest level of support for students with DLD. Literacy tasks were rated the most difficult across stakeholder groups. However, comparison between stakeholder groups showed statistically significant differences between ratings for six (of seven) areas of functioning. Statistically significant differences were identified when rating the difficulty of four (of seven) school‐based task subscales. Additional time and visual supports were rated the most helpful educational supports across groups. Overall, teachers and allied health professionals rated areas of functioning and school‐based tasks as more difficult than parents/caregivers, although they shared similar perspectives on five (of six) educational support subscales.
Conclusions & Implications
Literacy and language/communication are the areas of functioning rated to be most impacting learning for students with DLD. However, literacy tasks were reported to be the most difficult for students with DLD to complete. Teachers, allied health professionals and parents/caregivers are recommended to regularly discuss the areas of functioning, school‐based tasks and educational support to facilitate inclusive educational practices. Future research needs to consider the perspectives of students with DLD.
WHAT THIS PAPER ADDS
What is already known on the subject
There is extensive evidence demonstrating the increased risk of academic failure for students with DLD, particularly with literacy and numeracy. Although research on academic achievement or individual groups has occurred, limited research has compared stakeholders supporting students with DLD, which is vital for collaboration and optimal inclusive educational practices.
What this study adds to the existing knowledge
Teachers, allied health professionals and parents/caregivers have unique roles in the education of students with DLD and show differing perspectives that may link to these roles. Literacy and language/communication were the areas of functioning rated as most impacting learning, whilst literacy tasks were the most difficult activity undertaken at school for primary and secondary school‐aged students with DLD. Additional time and visual support were rated as the most helpful educational supports for students with DLD.
What are the practical and clinical implications of this work?
Stakeholders demonstrate variable views on the areas of functioning and school‐based tasks requiring support for students with DLD; however, they agreed on the helpfulness of most educational supports. Participants rated social/emotional tasks easier and their related supports less helpful than other areas of functioning. Given the associations between academic underachievement and mental health difficulties, more consideration needs to be given to the social/emotional well‐being of students with DLD in school. Taken together, establishing differences in perspective will help with the implementation of inclusive educational practices.
... Language skills are critical for many aspects of educational attainment including literacy (Hjetland, Brinchmann, Scherer, Hulme, & Melby-Lerv ag, 2020;Hulme, Nash, Gooch, Lerv ag, & Snowling, 2015;Snow, 2016) and numeracy (Chow & Ekholm, 2019;Hornburg, Schmitt, & Purpura, 2018) as well as psycho-social development (Norbury et al., 2016; van Agt, Verhoeven, van den Brink, & de Koning, 2011). Furthermore, it is well established that children from disadvantaged homes typically show poorer language development than children from more privileged backgrounds (Guo & Harris, 2000;Hart & Risley, 1995;Roulstone, Law, Rush, Clegg, & Peters, 2011;Sampson, Sharkey, & Raudenbush, 2008;Sirin, 2005). ...
Background
Oral language skills provide the foundation for formal education, and children may require language support over an extended period of time to maximise their education potential. Most work on language intervention, however, has focussed on the preschool or early school years. Here, we describe the development and evaluation of the Oral Language for Literacy Intervention (OLLI) programme which is designed to support children with weak language skills in the later primary school years.
Methods
We conducted a randomised control trial in 33 schools (50 classrooms). The language skills of all 8–9 year‐old children in each participating classroom (n = 1,423) were assessed using an automated app (LanguageScreen). The six children with the weakest LanguageScreen scores within each classroom (n = 296) were randomly allocated to the intervention (n = 148) or control group (n = 148). The children in the intervention group received the OLLI programme delivered in individual and small group sessions over 20 weeks. Children in the control group received their typical teaching.
Results
Children receiving the OLLI programme made significantly larger gains than children in the control group on a preregistered latent variable reflecting standardised measures of oral language ability (d = 0.38) and on a measure of their written expression (d = 0.42).
Conclusions
These findings have important implications for improving educational attainment in children in the late primary school years. The OLLI programme is designed to be deliverable at scale and is of relatively low cost.
... Two evidence-based observations underscore the importance of early follow-up for these children. First, the prevalence of children with DLD is not negligible, ranging from approximately 2%-11%, depending on the inclusion criteria and age of assessment (Calder et al., 2022;Norbury et al., 2016;Tomblin et al., 1997). Second, children with low language skills frequently face poor outcomes in reading and other academic domains Storch & Whitehurst, 2002), as well as in long-term social and academic areas (Clegg et al., 2005;Del Tufo & Earle, 2020;Gough Kenyon et al., 2022;Ziegenfusz et al., 2022), and in employment and daily life (Dubois et al., 2020). ...
Purpose
This study aimed to evaluate the stability of phonological awareness (PA) and language achievements between kindergarten and first grade among Arabic-speaking children.
Method
A total of 1,158 children were assessed in PA and language skills in both grades and were classified based on distinct and integrated achievements on PA and language following percentiles' cutoff criteria. The classification of distinct achievements constituted high, intermediate, low, and very low achievement-based groups for each domain. The classification of the integrated achievements on both domains constituted four groups: intermediate-high PA and language, very low PA, very low language, and doubly low (very low PA and language). Descriptive statistics and McNemar's tests were used to examine the stability of these groups.
Results
The analyses showed a significant improvement in achievements on most tasks. The distinct classification for PA and language indicated that many more kindergarteners in the extreme distribution with high and very low achievement levels maintained this profile in first grade compared to those with intermediate achievements. For PA, 55.7% of kindergarteners with high, 30% with intermediate, 30.4% with low, and 45.5% with very low achievements maintained their achievements in first grade. For language, 52.5% of kindergarteners with high, 34.5% with intermediate, 38.8% with low, and 59.8% with very low achievements maintained their language achievements. The integrated classification indicated a higher achievement stability rate for kindergarteners with intermediate-high PA and language (91.3%) and for doubly low achievers (84.7%) compared to very low PA (24.1%) or very low language (31.8%) achievers.
Conclusions
The study indicated a higher variability in the distribution of the intermediate achievements compared to the high and very low achievements, which were more stable across grade. The results emphasize the need for dynamic linguistic assessments and early intervention for children with very low achievements in PA and language who show a poor prognosis.
... Global prevalence estimates indicate that 6%-8% of children experience unexplained difficulty with language (ie, both using and understanding language); a figure that equates to approximately two children in every classroom. [1][2][3] An individual can be diagnosed with (developmental) language disorder (DLD) if language difficulties are persistent and confer significant functional impact in the absence of a differentiating condition (such as autism or intellectual disability) in which language disorder may also occur. 4 DLD is the diagnostic term agreed by international ...
Objective
This study aims to explore the educational, occupational and socioemotional experiences of people with developmental language disorder (DLD) across the lifespan to gain insight into risk and protective factors for mental health.
Design
Qualitative analysis of focus groups and written submissions. Data were combined and analysed using Braun and Clarke’s reflexive thematic analysis approach within a critical realist framework.
Setting
Southeast England and Western Australia.
Participants
Six adults with DLD from England and five speech-language therapists from Western Australia participated in focus groups and/or contributed written responses to the research team.
Results
We developed four themes: ‘perspectives on diagnosis and living with an invisible disability’ explores participants’ perspectives on diagnosis, the difficulty getting a diagnosis and perceptions of DLD as widely misunderstood; ‘school struggles and self-esteem from past to present’ details school experiences and their impact on mental health; ‘DLD across the lifespan’ explores DLD in adulthood with a focus on workplace difficulties, emotional well-being and mental health; ‘A sense of belonging: communication, connection and support’ provides a lived experience account into the social participation difficulties of adults with DLD and the importance of social support.
Conclusions and implications
Adults with DLD may experience poor self-esteem, anxiety and depression. These mental health concerns may result from (a) exhaustion due to masking/compensating for neurodevelopmental differences, (b) loneliness and/or disempowerment due to difficulties with social interaction and (c) adverse experiences such as bullying, discrimination and a lack of appropriate accommodation at school and in the workplace. A lack of awareness and support for people with DLD from health, education and employment providers was also seen as a contributing factor to poor mental health. Diagnosis may serve a protective function for mental health via self-understanding, self-esteem and self-advocacy.
... Developmental language disorder (DLD), in turn, is a common and heterogeneous neurodevelopmental disorder that occurs during childhood (Bishop, 2017;Georgiou & Spanoudis, 2021) and affects 3% to 7% of children (Norbury et al., 2016). The term applies to significant difficulties in one or more language domains, in expressive and/or receptive language that affect communication and learning without an associated biomedical condition (Bishop et al., 2016. ...
Using language for social purposes can be a real challenge for children with autism spectrum disorder (ASD) and developmental language disorder (DLD). Despite the positive effects of the Pragmatic Intervention Programme (PICP) already known in both populations, the effects needed to be established with a larger sample and analysed separately for each condition. This study aims to analyse the effectiveness of PICP on preschool-age children with ASD or DLD with pragmatic impairment. A non-randomised controlled trial was conducted. Thirty-six children were assigned to experimental ( n = 22) or control group (waiting list) ( n = 14). Each child attended 24 PICP-based intervention sessions provided by a speech and language therapist. The primary outcome measure was a Goal Attainment Scale (GAS). The secondary outcomes were Escala de Avaliação de Competências Comunicativas (EAC) and Teste de Linguagem – Avaliação da Linguagem Pré-Escolar (TL-ALPE). The results indicated that all children achieved clinically significant progress in GAS after intervention. Statistically significant differences were observed between the experimental and control groups in the EAC and TL-ALPE after post-intervention assessment (T2). These results reinforce that PICP improves language in preschool-age children with ASD and DLD with pragmatic impairment. Differences between conditions and implications for future studies are discussed.
Lay abstract
Children diagnosed with autism spectrum disorder (ASD) and developmental language disorder (DLD) often have difficulties using language in social contexts. An intervention programme for preschool-age children with pragmatic difficulties, called Pragmatic Intervention Programme (PICP), showed positive effects for these children. However, it was important to confirm these effects with a larger group and analyse them separately for each condition. In this study, the effectiveness of the PICP was analysed in preschool-age children with ASD or DLD with difficulties in using language in social contexts. The study was carried out with 36 children. Twenty-two were allocated to an experimental group to receive the PICP-based intervention first, and 14 children were assigned to a control group (waiting list). Each child attended 24 PICP-based intervention sessions provided by a speech and language therapist. Progress was measured using a Goal Attainment Scale (GAS) and other language assessment instruments. The results showed that all children in the experimental group made significant progress in their language competencies, compared to the control group after the intervention. This study confirms that the PICP is effective in improving language competencies in preschool-age children with ASD and DLD with difficulties in using language for social purposes, regardless of their condition. These results emphasise the importance of tailored interventions for these children and point to areas for further research.
... A language disorder is a type of neurodivergence which is characterised by challenges with speaking and understanding language that can impact on education, social interactions and mental health. Around 10 per cent of children in the UK have language disorder (Norbury et al., 2016). Within this, 2.3 per cent of children have a known biomedical condition associated with their language disorder, e.g. ...
Introduction
Developing daily living skills, such as self-care, cooking and managing money, is a key priority for adolescents with special educational needs. Previous studies investigated the emergence of daily living skills in young people with a range of neurodevelopmental conditions. However, none focused on adolescents with language disorders, including developmental language disorder.
Method
Two groups of 16-year-olds participated in this study: a typically developing group ( n = 88) and a (developmental) language disorder group ( n = 78), which was subdivided into participants with co-occurring motor difficulties ( n = 56) versus typical motor development ( n = 22). Data were collected using the WHEEL OF INDEPENDENCE™ framework, a daily living skills measurement tool. Between-group comparisons assessed whether there were significant differences in daily living skills between typically developing and (developmental) language disorder participants and between those with and without motor difficulties within the (developmental) language disorder group.
Results
Findings revealed that typically developing participants had significantly better daily living skills than the (developmental) language disorder group. Within the (developmental) language disorder group, participants with motor difficulties showed marginally significantly lower daily living skills than those without.
Conclusion
Adolescents with (developmental) language disorder experience challenges developing their daily living skills, compared to typically developing peers. This may be compounded if they have co-occurring motor difficulties. Further research could inform understanding of the mechanisms underlying these differences in order to develop tailored and effective interventions.
... The term DLD is inclusive of earlier terminology, such as specific language impairment (SLI), as well as related terms, such as language difficulties and language disorder, and the term is used accordingly in this article. The prevalence of DLD is about 7% in children at school entry (Norbury et al., 2016). ...
Students with developmental language disorder, DLD, are at risk of facing educational challenges in compulsory school. The aim of this study was to identify factors with the potential to support or impede learning in students with DLD and thereby contribute to the development of appropriate interventions for this group of students. Through individual semi-structured interviews, data was collected from 15 participants in five stakeholder groups: students with DLD, parents, teachers, support persons and SLPs. By using Reflexive thematic analysis, three themes were developed from the interview material: 1) Individual support facilitates learning; 2) The demands of oral and written language differ; and 3) Social relations supply and consume energy. The results provide insight into how DLD may lead to challenges in both learning situations and in social relations, but also about how support may reduce the consequences of DLD. Abstract på svenska Elever med utvecklingsrelaterad språkstörning (DLD) riskerar att möta utmaningar i grundskolan. Syftet med denna studie var att identifiera faktorer som intressenter upplevde har en potential att underlätta eller försvåra lärande hos elever med DLD och därmed bidra till att utveckla ett lämpligt stöd för denna grupp elever i skolsammanhang. Genom individuella semistrukturerade intervjuer samlades data in från 15 deltagare i fem grupper av intressenter: elever med DLD (n = 3), föräldrar (n = 3), lärare (n = 3), resurspersonal (n = 3) och logopeder (n = 3). Genom att använda reflexiv tematisk analys utvecklades tre teman från intervjumaterialet: (1) Individuellt stöd underlättar lärande; (2) kraven på muntligt och skriftligt språk skiljer sig åt; och (3) sociala relationer tillhandahåller och konsumerar energi. Resultaten ger insikt i hur DLD kan innebära utmaningar i både inlärningssituationer och sociala relationer och om hur stöd kan minska konsekvenserna av DLD. Den svenska versionen av abstractet lades till i version 2 av denna artikel. Översättningen gjordes av tidskriftens redaktion.
... DLD is a heterogeneous neurodevelopmental disorder that emerges in early childhood and persists into adulthood. It affects approximately 7.5% of children (Norbury et al., 2016) and is characterized by language difficulties with no known differentiating condition such as autism spectrum disorder, cerebral palsy, brain injury, or sensorineural hearing loss (Bishop et al., 2016(Bishop et al., , 2017. These difficulties may affect one or several language domains including phonology, morphology, syntax, semantics, and/or pragmatics. ...
Purpose
Although children with developmental language disorder (DLD) are known to have difficulties with emergent literacy skills, few available studies have examined emergent literacy skills in Arabic-speaking children with DLD. Even though Arabic language characteristics, such as diglossia and orthographic structure, influence the acquisition of literacy in Arabic-speaking children, research shows that oral language skills, such as vocabulary, and cognitive skills, such as verbal short-term memory (VSTM), predict literacy in Arabic-speaking children. Moreover, linguistic and memory abilities are impaired in children with DLD, including Arabic-speaking children. The current study examines the relationships between oral language, VSTM, and emergent literacy skills in Arabic-speaking typically developing (TD) children and children with DLD.
Method
Participants were 40 TD children (20 girls; aged 4;0–6;11 [years;months]) and 26 children with DLD (nine girls, aged 4;0–6;11). All participants were monolingual Arabic speakers and matched on age and socioeconomic status. A set of comprehensive Arabic language (vocabulary knowledge, morphosyntactic, and listening comprehension skills), VSTM, and emergent literacy (phonological awareness and letter knowledge skills) tests were administered.
Results
The DLD group scored significantly lower than the TD group on language, VSTM, and emergent literacy measures. Results revealed that the contributions of oral language and VSTM to emergent literacy skills across TD and DLD groups were different. In the TD group, VSTM predicted emergent literacy skills, whereas in the DLD groups, both vocabulary knowledge and VSTM predicted emergent literacy skills.
Conclusions
This study represents an important first step in understanding emergent literacy skills and their relationships to language and memory in Arabic-speaking children with and without DLD. The implications of these findings for clinical and education provision are discussed.
... Cabe destacar la mayor proporción de niños frente a niñas que participaron en este estudio (3:1). Ello contrasta con lo reportado en la literatura que señala una prevalencia en el TDL de 1.22:1, aunque esta diferencia no se considera significativa (Norbury et al., 2016). Este fenómeno puede explicarse por el proceso de selección utilizado por los Equipos de Orientación Psicopedagógica y de Atención Temprana (EOEP) de cada colegio, quienes tendieron a remitir mayoritariamente a alumnos varones, al considerar que estos cumplían con los criterios de alteraciones del lenguaje para su posterior administración del CELF-4. ...
Algunos niños con TDL pueden experimentar una alteración en su sistema fonológico, lo que podría ocasionarles dificultades en la producción del habla. Estas dificultades se manifiestan en errores de sustitución, estructura de la sílaba y distorsiones, lo que se traduce en mayor cantidad de procesos de simplificación fonológica (PSF) que los esperados para su edad. El objetivo principal del presente estudio fue implementar un programa de intervención fundamentado en los principios de los enfoques de estimulabilidad y psicolingüístico para mejorar la producción del habla en niños con TDL. Para este propósito, se aplicó un programa de intervención a 24 alumnos de 5 años diagnosticados con TDL mediante el CELF-4. Las producciones fonológicas fueron evaluadas mediante la aplicación del Registro Fonológico Inducido (RFI). El programa de intervención se organizó bajo un Sistema de Apoyo de Múltiples Niveles (MTSS), con un total de 30 sesiones de intervención de 15 minutos de duración cada una. Las actividades se configuraron bajo los criterios del apoyo gestual de los fonemas y de la metafonología. Los resultados muestran una reducción significativa PSF luego de la intervención. Esta reducción ocurrió principalmente en los PFS que afectan a los niveles de palabra y de sílaba. A partir de estos resultados, podemos concluir que una intervención que combina estos enfoques logra reducir de manera sustancial los PFS. En investigaciones futuras, se propone explorar el impacto de aumentar la duración de cada sesión y el número de ensayos para cada objetivo, conforme lo sugiere la literatura.
Background In areas of social disadvantage up to 40–50% of children enter preschool with speech and language skills significantly poorer than would be expected for their age. The Happy Talk trial tests if a community embedded, targeted selective speech and language programme that simultaneously engages with parents and early childhood educators, (1) improves language outcomes in children aged between 2 years 10 months and 6 years and (2) is cost effective for the health care system. Method The Happy Talk trial is a large scale cluster randomised trial of a 12-week manualised intervention delivered in pre/school settings serving socially disadvantaged communities, in Ireland. Seventy-two clusters will receive the intervention (12 participants per cluster). Parents and pre/school staff engage in group training and coaching in the form of 12 1-hour sessions for parents and four staff workshops, over the course of the pre/school year. Training/coaching includes core interaction skills (modelling, expanding, balancing questions and comments), early literacy and phonological awareness. Blinded assessments pre- and immediately post-intervention and at 6 months follow up, will measure the primary outcomes of children’s receptive and expressive language and functional impact, and secondary outcomes of quality of life. Parental responsiveness and educator-child interactions will also be evaluated. Discussion This robust study evaluates a public health approach to the delivery of speech language and communication intervention in the ‘real world’ in the community, which focuses on prevention and equity of access. Pilot work indicates that the programme is feasible, acceptable to parents and staff, cost effective, and suitable for implementation at scale. The trial includes a process evaluation, a well-developed economic evaluation and the outcomes are directly relevant to children, families and educators. This work has the potential to improve the long-term outcomes and life chances of people living in social disadvantage. Trial registration clinicaltrials.gov NCT06460090 Trial Management There is a formal governance structure to oversee the conduct and running of the trial, consisting of a trial management group and a steering committee. More details on the composition, roles and responsibilities of each committee can be found in the supplemental material.
Purpose
Our overarching goal is to advance our understanding of clinical decision-making processes in bilingual language and literacy assessment. When evaluating bilingual children, speech-language pathologists (SLPs) use static norm-referenced assessments (SAs) developed for English monolinguals more frequently than less biased dynamic assessments (DAs). To date, no research has considered why SLPs use SAs over DAs or examined SLPs’ conceptualization of validity beyond knowledge of psychometrics. In this study we explore factors that affect SLPs’ choice and use of assessments and how clinicians conceptualize and employ validity through the lens of modern validity frameworks.
Method
Canadian SLPs (n=21) participated in semi-structured interviews, using a guide informed by the Theoretical Domains frameworks and Kane’s Validity framework. Reflexive thematic analysis was used to generate themes.
Results
Clinicians rarely report using “dynamic assessment” but did “assess dynamically” by incorporating teaching in testing. When assessing oral language, SLPs acknowledged that using SAs with bilinguals may be inappropriate, but that they continue to do primarily because scores from these measures are necessary for diagnosis and accessing services. To contend with this friction between clinical beliefs and workplace requirements, most SLPs report caveats alongside SA scores SAs to contextualize findings. Though individual clinical knowledge of psychometrics and validity in assessment varies, systemic issues play a key role in perpetuating current assessment practices with bilinguals. Finally, bilingual literacy assessment practices differ. Clinicians use a wider variety of assessments and rely less on scores to achieve desired outcomes for students.
Conclusion
Clinical decision-making in bilingual language and literacy assessment is influenced by both individual and contextual factors. Accordingly, efforts to shift practice patterns cannot solely focus on individual clinical knowledge but must also examine and address these systemic issues.
Background In areas of social disadvantage up to 40–50% of children enter preschool with speech and language skills significantly poorer than would be expected for their age. The Happy Talk trial tests if a community embedded, targeted selective speech and language programme that simultaneously engages with parents and early childhood educators, (1) improves language outcomes in children aged between 2 years 10 months and 6 years and (2) is cost effective for the health care system. Method The Happy Talk trial is a large scale cluster randomised trial of a 12-week manualised intervention delivered in pre/school settings serving socially disadvantaged communities, in Ireland. Seventy-two clusters will receive the intervention (12 participants per cluster). Parents and pre/school staff engage in group training and coaching in the form of 12 1-hour sessions for parents and four staff workshops, over the course of the pre/school year. Training/coaching includes core interaction skills (modelling, expanding, balancing questions and comments), early literacy and phonological awareness. Blinded assessments pre- and immediately post-intervention and at 6 months follow up, will measure the primary outcomes of children’s receptive and expressive language and functional impact, and secondary outcomes of quality of life. Parental responsiveness and educator-child interactions will also be evaluated. Discussion This robust study evaluates a public health approach to the delivery of speech language and communication intervention in the ‘real world’ in the community, which focuses on prevention and equity of access. Pilot work indicates that the programme is feasible, acceptable to parents and staff, cost effective, and suitable for implementation at scale. The trial includes a process evaluation, a well-developed economic evaluation and the outcomes are directly relevant to children, families and educators. This work has the potential to improve the long-term outcomes and life chances of people living in social disadvantage. Trial registration clinicaltrials.gov NCT06460090 Trial Management There is a formal governance structure to oversee the conduct and running of the trial, consisting of a trial management group and a steering committee. More details on the composition, roles and responsibilities of each committee can be found in the supplemental material.
Bilingual children's language skills are strongly influenced by exposure to each of their languages, among other linguistic, environmental, and cognitive factors. In the speech and language therapy clinic, it is difficult to disentangle developmental language disorders from insufficient exposure. Dynamic assessment, which directly tests the learning potential of children, offers a promising solution for this dilemma. This study compares the clinical potential of two dynamic assessment situations, varying amount of adult mediation (autonomous computer game vs. interactive story reading with graduated cues), as well as item types (nouns, verbs, and inflections in sentences) and linguistic modalities and tasks (comprehension - word picture matching and acceptability judgement, production - free recall and picture naming). Forty-nine French monolingual and French-Portuguese bilingual children with and without developmental language disorder, aged 5;0 to 7;11 years, were include in the final analyses. Using Lasso regressions, we were able to determine which variables best explain the presence of disorder. A combination of all item types and predominantly receptive tasks, mostly from the interactive situation, was retained for very high classification accuracy (up to 100% sensitivity and 96% specificity). Language status showed no influence, which encourages the use of dynamic assessment in the context of speech and language assessment with bilingual children. This study adds to evidence that dynamic assessment is a promising task for identifying bilingual and monolingual children with developmental language disorder, particularly when the situation involves interaction with graduated cues.
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.
Supporting children’s language development, particularly oral language, is crucial as it constitutes the basis for the further development of literacy skills. This study explored patterns of primary school children’s expressive language productivity over time in relation to a professional development (PD) program designed to further teachers’ use of communication-supporting strategies to promote child talk. Framed by a Tier 2 response to intervention model, teacher-child verbal interactions were observed during structured small-group conversations. The participants were 36 children (M age 8;2 years old), with and without speech, language and communication needs (SLCN) attending three mainstream classes in two Swedish municipalities. Two teachers followed a 10-week PD program, and a third teacher participated for comparison purposes. We measured the children’s expressive language productivity in relation to the teachers’ strategy use pre-intervention, post-intervention, and at a two-month follow-up. In the results, we found a tendency that when the teachers used the strategies frequently, the children’s expressive language productivity seemed suppressed. Although the results showed a large variation in the children’s expressive language productivity, a tentative conclusion is that the children with SLCN may also be stimulated and willing to participate verbally during this type of small-group conversation. This finding suggests support for an inclusive Tier 2 approach of mixed groups with both children with and without SLCN. Based on our findings, we also suggest stressing in the PD program the need for teachers to balance their strategy use in the interactions with the children to provide ample opportunities for the children to talk and express themselves.
Background
It is known that impairments in linguistic ability and motor function tend to co-occur in children, and that children from families with parental mental illness such as schizophrenia tend to perform poorly in both domains, but the exact nature of these links has not yet been fully elucidated.
Design
In this study, we leveraged the first wave of the Danish High Risk and Resilience Study (VIA 7), which includes both genetic data and measures covering multiple developmental domains. The VIA 7 cohort comprises 522 7-year-old children born to parents with schizophrenia (N = 202), bipolar disorder (N = 120) or neither (N = 200). We investigated the relationships between linguistic ability and motor function using correlation and regression analyses, focusing on developmental coordination disorder (DCD) and specific language impairment (SLI) and their potential associations with the three risk groups.
Results
We found significant correlations between most measures of language and motor function and significant associations of DCD and SLI with language and movement measures, respectively, the largest effect being that of DCD on receptive language, with a significant interaction effect: DCD was associated with poorer performance in children from schizophrenia families compared to bipolar disorder and control families. Both disorders showed higher prevalence among children with familial high risk of mental illness. We did not find significant evidence of genetic overlap between DCD and SLI.
Conclusions
Our results suggest strong links between the domains of motor function and linguistic ability. Children of parents with schizophrenia are at high risk of comorbid language and movement disorders.
The purpose of the current study was to expand upon previous research on RECALL, a dialogic reading intervention modified for autistic children aimed at increasing engagement. Children ages 3–6 years (n = 6) with language delays with or without co-occurring autism were tested using a multiple baseline across participants design. During baseline, the interventionist used dialogic reading and asked questions after every page. During intervention, the interventionist used RECALL, including a least to most prompting hierarchy with visual prompt cards. Children were more responsive and produced more meaningful correct responses during the intervention. Response type (linguistic vs. non-linguistic) also changed from baseline to intervention, though the pattern varied across participants. Intervention was not associated with increased responsiveness to adult bids for attention or pauses designed to encourage the child to initiate an interaction, though a few children showed changes in these responses over time.
Children with language disorders face different challenges in their daily school routines. Accessing tools and having resources promoting a well-structured and inclusive environment is necessary to ensure a pleasant and successful passage through primary school.
The current article seeks to highlight stimulating ideas, creating a foundation for involving everyone caring for and educating students with language disorders, particularly children with special needs. Moreover, experts need to prioritize educational initiatives aimed at language disorders, particularly emphasizing early detection, prevention, and specialized care. Balancing the need for students to get adequate attention while avoiding unequal treatment can be as difficult as dealing with a two-sided coin. Moreover, it is crucial to acknowledge that academic research should prioritize finding the best ways to support students with special needs who have language impairments. All professionals working with these students, such as speech therapists, psychopedagogical experts, and general therapists, need to focus on developing interventions and options to aid in their growth.
Background
Children and adolescents with language problems have poorer mental health compared with their non‐language impaired peers. Less is known about mental health in adults with a history of language problems. This paper presents a systematic review and meta‐analysis that addresses this gap in the literature. Specifically, it summarises the results from studies examining anxiety and depression in adults (aged 18 years and over) who were identified with language impairments or problems earlier in development.
Methods & Procedures
Five electronic databases (PsycINFO, ERIC, CINAHL, EMBASE and PubMed) were searched for studies comparing anxiety and/or depression in a sample of adults with and without a history of language problems. Nine studies were found that met the inclusion criteria. From each, an odds ratio (OR) was computed measuring the relationship between childhood language problems and anxiety or depression in adulthood. The OR was computed so values > 1 which indicated anxiety/depression were associated with a history of language problems. ORs were averaged using multilevel random effects meta‐analysis.
Outcomes & Results
Averaging the study's findings across both anxiety and depression outcomes, we found that a history of childhood language problems was associated with poorer mental health in adulthood (OR = 1.79, p = 0.004). The association for anxiety was also significant (OR = 1.80, p = 0.012) and close to statistical significance for depression (OR = 1.60, p = 0.054).
Conclusions & Implications
This review reveals that adults with a history of language problems are more likely to experience poorer mental health outcomes compared with controls. These findings demonstrate childhood language problems affect not only communication but also mental health and well‐being in the long term.
WHAT THIS PAPER ADDS
What is already known on the subject
Prior research examining mental health in children and adolescents with language problems reveals a twofold increased risk of internalising problems, including anxiety and depression. However, little is known about mental health outcomes in adults with a history of language problems.
What this paper adds to the existing knowledge
The main finding was that childhood language problems are associated with increased risk of anxiety and depression in adulthood.
What are the practical and clinical implications of this work?
First, the study demonstrates childhood language problems increase the risk of poor mental health in adulthood. Second, in adult mental health settings there is a need to screen for language problems and, where applicable, adjust interventions to accommodate communicative needs for patients/clients. Solving these issues requires integration and recognition of the importance of speech–language therapy in the adult mental health system.
Objectives: This study aimed to develop the “Speech Language Early Literacy Screening Checklist” in order to identify speech, language, and early literacy difficulties in children aged 5-6 years before entering elementary school. This study examined the reliability, validity, sensitivity, specificity, positive predictive value, and negative predictive value to verify the accuracy and efficiency of the checklist as a screening tool.Methods: Out of the 2,880 children who participated in the initial screening test, 155 underwent diagnostic deep tests. A total of 110 children who exhibited difficulties in language, speech, and early literacy areas were classified as the high-risk group, while those who demonstrated appropriate development in all areas were classified as the general group.Results: The Cronbach’s α value for all checklist items was .884. The content validity index rated by six language development experts was 0.70 or higher for all 36 items, with an average content validity score of 0.91. Clinical validity was confirmed through the total score differences between the general and high-risk groups classified by the diagnostic deep tests. The receiver operating characteristic (ROC) curve results for the screening checklist showed an area under the curve (AUC) of 0.858, sensitivity of 84.4%, and specificity of 76.4%. The positive predictive value (PPV) calculated from the cut-off score was 92.3%.Conclusion: The “Speech Language Early Literacy Screening Checklist” developed to identify children at high risk of language development delays before school entry has shown appropriate reliability, validity, and classification accuracy. This study suggests that the implementation of this checklist will contribute to preventing school failure by effectively identifying at-risk children aged 5-6.
Background
The youngest children in an academic year are reported to be educationally disadvantaged and overrepresented in referrals to clinical services. In this study we investigate for the first time whether these disadvantages are indicative of a mismatch between language competence at school entry and the academic demands of the classroom.Methods
We recruited a population sample of 7,267 children aged 4 years 9 months to 5 years 10 months attending state-maintained reception classrooms in Surrey, England. Teacher ratings on the Children's Communication Checklist-Short (CCC-S), a measure of language competence, the Strengths and Difficulties Questionnaire-Total Difficulties Score (SDQ), a measure of behavioural problems, and the Early Years Foundation Stage Profile (EYFSP), a measure of academic attainment, were obtained at the end of the reception year.ResultsThe youngest children were rated by teachers as having more language deficits, behaviour problems, and poorer academic progress at the end of the school year. Language deficits were highly associated with behaviour problems; adjusted odds ratio 8.70, 95% CI [7.25–10.45]. Only 4.8% of children with teacher-rated language deficits and 1.3% of those with co-occurring language and behaviour difficulties obtained a ‘Good Level of Development’ on the EYFSP. While age predicted unique variance in academic attainment (1%), language competence was the largest associate of academic achievement (19%).Conclusion
The youngest children starting school have relatively immature language and behaviour skills and many are not yet ready to meet the academic and social demands of the classroom. At a population level, developing oral language skills and/or ensuring academic targets reflect developmental capacity could substantially reduce the numbers of children requiring specialist clinical services in later years.
This paper reports a longitudinal follow-up of 71 adolescents with a preschool history of speech-language impairment, originally studied by Bishop and Edmundson (1987). These children had been subdivided at 4 years into those with nonverbal IQ 2 SD below the mean (General Delay group), and those with normal nonverbal intelligence (SLI group). At age 5;6 the SLI group was subdivided into those whose language problems had resolved, and those with persistent SLI. The General Delay group was also followed up. At age 15–16 years, these children were compared with age-matched normal-language controls on a battery of tests of spoken language and literacy skills. Children whose language problems had resolved did not differ from controls on tests of vocabulary and language comprehension skills. However, they performed significantly less well on tests of phonological processing and literacy skill. Children who still had significant language difficulties at 5;6 had significant impairments in all aspects of spoken and written language functioning, as did children classified as having a general delay. These children fell further and further behind their peer group in vocabulary growth over time.
This study explored the effects of oral communication and demographic characteristics on intervention receipt. Oral communication characteristics included speech-sound production and receptive and expressive language status. Demographic characteristics included race, sex, residential strata, and neighborhood income level. With regard to speech-sound production and language, 1,929 kindergartners were divided into four speech-language subgroups: speech impaired only, language impaired only, speech and language impaired, and normal in both speech and language. In terms of expressive and receptive language modalities, the group of children was divided into four expressive-receptive subgroups: expressive impaired only, receptive impaired only, expressive and receptive impaired, and normal in both expressive and receptive language. Associations of speech versus language and expressive language versus receptive language with intervention receipt were examined in both categorical and continuous manners. Results showed that speech had a stronger effect on intervention receipt than language, but that this difference could not be explained by the effect of speech on social and academic functions compared to that of language. Expressive language had a stronger effect on intervention receipt than receptive language (when treated as continuous variables). This also could not be explained by the effect of these variables on social and academic function. These results suggest that the current referral and service delivery system depends on communication characteristics that are expressive and, thus, most readily observable. This referral and service delivery approach, however, fails to identify children that have the greatest social and academic risks. Methods of reversing this trend were discussed. Among all demographic variables examined, only sex is related to intervention receipt, that is, boys were more likely to have received intervention.
The World Health Organization is in the process of preparing the eleventh revision of the International Classification of Diseases (ICD-11), scheduled for presentation to the World Health Assembly for approval in 2017. The International Advisory Group for the Revision of the ICD-10 Mental and Behavioural Disorders made improvement in clinical utility an organizing priority for the revision. The uneven nature of the diagnostic information included in the ICD-10 Clinical Descriptions and Diagnostic Guidelines (CDDG), especially with respect to differential diagnosis, is a major shortcoming in terms of its usefulness to clinicians. Consequently, ICD-11 Working Groups were asked to collate diagnostic information about the disorders under their purview using a standardized template (referred to as a "Content Form"). Using the information provided in the Content Forms as source material, the ICD-11 CDDG are being developed with a uniform structure. The effectiveness of this format in producing more consistent clinical judgments in ICD-11 as compared to ICD-10 is currently being tested in a series of Internet-based field studies using standardized case material, and will also be tested in clinical settings.
© 2015 World Psychiatric Association.
Background
There is no agreed terminology for describing childhood language problems. In this special issue Reilly et al. and Bishop review the history of the most widely used label, ‘specific language impairment’ (SLI), and discuss the pros and cons of various terms. Commentators from a range of backgrounds, in terms of both discipline and geographical background, were then invited to respond to each lead article.
Aims
To summarize the main points made by the commentators and identify (1) points of consensus and disagreement, (2) issues for debate including the drivers for change and diagnostic criteria, and (3) the way forward.
Conclusions & Implications
There was some common ground, namely that the current situation is not tenable because it impedes clinical and research progress and impacts on access to services. There were also wide-ranging disagreements about which term should be adopted. However, before debating the broad diagnostic label it is essential to consider the diagnostic criteria and the systems used to classify childhood language problems. This is critical in order to facilitate communication between and among clinicians and researchers, across sectors (in particular health and education), with the media and policy-makers and with families and individuals who have language problems. We suggest four criteria be taken into account when establishing diagnostic criteria, including: (1) the features of language, (2) the impact on functioning and participation, (3) the presence/absence of other impairments, and (4) the language trajectory or pathway and age of onset. In future, these criteria may expand to include the genetic and neural markers for language problems. Finally, there was overarching agreement about the need for an international and multidisciplinary forum to move this debate forward. The purpose would be to develop consensus regarding the diagnostic criteria and diagnostic label for children with language problems. This process should include canvassing the views of families and people with language problems as well as the views of policy-makers.
Background:
The term 'specific language impairment' (SLI), in use since the 1980s, describes children with language impairment whose cognitive skills are within normal limits where there is no identifiable reason for the language impairment. SLI is determined by applying exclusionary criteria, so that it is defined by what it is not rather than by what it is. The recent decision to not include SLI in DSM-5 provoked much debate and concern from researchers and clinicians.
Aims:
To explore how the term 'specific language impairment' emerged, to consider how disorders, including SLI, are generally defined and to explore how societal changes might impact on use the term.
Methods & procedures:
We reviewed the literature to explore the origins of the term 'specific language impairment' and present published evidence, as well as new analyses of population data, to explore the validity of continuing to use the term.
Outcomes & results and conclusions & implications:
We support the decision to exclude the term 'specific language impairment' from DSM-5 and conclude that the term has been a convenient label for researchers, but that the current classification is unacceptably arbitrary. Furthermore, we argue there is no empirical evidence to support the continued use of the term SLI and limited evidence that it has provided any real benefits for children and their families. In fact, the term may be disadvantageous to some due to the use of exclusionary criteria to determine eligibility for and access to speech pathology services. We propose the following recommendations. First, that the word 'specific' be removed and the label 'language impairment' be used. Second, that the exclusionary criteria be relaxed and in their place inclusionary criteria be adopted that take into account the fluid nature of language development particularly in the preschool period. Building on the goodwill and collaborations between the clinical and research communities we propose the establishment of an international consensus panel to develop an agreed definition and set of criteria for language impairment. Given the rich data now available in population studies it is possible to test the validity of these definitions and criteria. Consultation with service users and policy-makers should be incorporated into the decision-making process.
Background
In domains other than language, there is fairly consistent diagnostic terminology to refer to children's developmental difficulties. For instance, the terms ‘dyslexia’, ‘attention deficit hyperactivity disorder’ and ‘autistic spectrum disorder’ are used for difficulties with reading, attention or social cognition, respectively. There is no agreed label, however, for children with unexplained language problems.AimsTo consider whether we need labels for unexplained language problems in children, and if so, what terminology is appropriate.Main ContributionThere are both advantages and disadvantages to labels, but they are important to ensure children receive services, and to increase our knowledge of the nature and causes of such problems. A survey of labels in current use found 132 different terms, 33 of which had 600 or more returns on Google Scholar between 1994 and 2013. Many of these labels were too general to be useful. Of the remainder, the term ‘specific language impairment’ was the most commonly used.Conclusions
The current mayhem in diagnostic labels is unsustainable; it causes confusion and impedes research progress and access to appropriate services. We need to achieve consensus on diagnostic criteria and terminology. The DSM-5 term ‘language disorder’ is problematic because it identifies too wide a range of conditions on an internet search. One solution is to retain specific language impairment, with the understanding that ‘specific’ means idiopathic (i.e., of unknown origin) rather than implying there are no other problems beyond language. Other options are the terms ‘primary language impairment’, ‘developmental language disorder’ or ‘language learning impairment’.
Purpose
This study used meta-analysis to investigate the difference in nonverbal cognitive test performance of children with specific language impairment (SLI) and their typically developing (TD) peers.
Method
The meta-analysis included studies (a) that were published between 1995 and 2012 of children with SLI who were age matched (and not nonverbal cognitive matched) to TD peers and given a norm-referenced nonverbal cognitive test and (b) that reported sufficient data for an effect size analysis. Multilevel modeling was used to examine the performance of children with SLI relative to their typically developing, age-matched peers on nonverbal IQ tests.
Results
Across 138 samples from 131 studies, on average children with SLI scored 0.69 standard deviations below their TD peers on nonverbal cognitive tests after adjusting for the differences in the tests used, the low-boundary cutoff scores, the age of the participants, and whether studies matched the two groups on socioeconomic status.
Discussion
The lower performance of children with SLI relative to TD children on nonverbal IQ tests has theoretical implications for the characterization of SLI and clinical and political implications regarding how nonverbal cognitive tests are used and interpreted for children with this disorder.
Purpose
This study examined the postschool educational and employment experiences of young people with and without specific language impairment (SLI).
Method
Nineteen-year-olds with (n = 50) and without (n = 50) SLI were interviewed on their education and employment experiences since finishing compulsory secondary education.
Results
On average, young people with SLI were less successful than their peers without SLI, but they did attain some achievements. Young people with SLI obtained ∼2, mostly vocational qualifications in the first few years post school. Young people continuing in education at 19 years were most commonly in lower level educational placements than their typically developing (TD) peers. Performance IQ and language/literacy skills were the strongest predictors of educational experience level at this age. Young people with SLI truant less and report feeling more supported than TD peers. In terms of employment, similar proportions of young people with and without SLI had jobs. A larger proportion of young people with SLI, however, were not in education, employment, or training at 19 years of age.
Conclusion
In the immediate postschool years, young people with SLI fare less well in education and employment than their TD peers.
Purpose
To investigate the longitudinal trajectories of verbal and nonverbal skills in individuals with a history of specific language impairment (SLI) from childhood to adolescence. This study focuses on SLI only and investigates within-participant measures across abilities.
Method
Verbal and nonverbal skills were assessed in 242 children with a history of SLI at ages 7, 8, 11, 14, 16, and 17. Discrete factor growth modeling was used to examine developmental trajectories for the whole group and to identify subgroups on the basis of a novel, developmental, multidimensional approach.
Results
When expressive language, receptive language, and nonverbal skills were scaled to a common metric, the group of individuals with a history of SLI as a whole had stable skills growth throughout the 10-year time frame. Seven language subgroups were identified, but these differed only in severity and did not display mutually distinctive patterns of growth development. In contrast, 6 nonverbal skills subgroups were identified, and their trajectories did differ significantly, with evidence of deceleration in around one third of the sample.
Conclusion
Individuals with a history of SLI show steady language growth from age 7. However, different patterns of growth of nonverbal skills are observed from childhood to adolescence.
The Diagnostic Evaluation of Articulation and Phonology, (DEAP) is a comprehensive, individually administered, norm-referenced battery designed to provide differential diagnoses of speech disorders in children ages 3.0-8.11 years. Five tests (two screens and three assessments) comprise the DEAP assessment process. Although you are not required to administer all test components, each screen can be administered in 5 minutes and each assessment in 15 minutes.
From the Diagnostic Screen results, you can determine if additional testing is needed and, if so, the appropriate DEAP test to administer. The Articulation, Phonology, and Word Inconsistency Assessments then help clinicians differentiate between disorders of articulation; delayed phonological development and consistent phonological disorders; and inconsistent phonological disorders, respectively. If there are concerns about a possible oral motor disorder, the Oral Motor Screen may be administered to determine if an in-depth assessment of oral motor skills is warranted.
Purpose
To draw on multiple sources of information to determine prevalence of speech and language impairment in young Australian children.
Method
Information about 4,983 children (ages 4–5 years) from Growing Up in Australia: The Longitudinal Study of Australian Children (Australian Institute of Family Studies, 2007) was obtained via parent interviews and questionnaires, teacher questionnaires, and direct assessment. Data were statistically weighted to the Australian population of 253,202 children in the target age group.
Results
Parent-reported prevalence: 25.2% had concerns about how their child talked and made speech sounds (11.8% “concerned”; 13.4% “a little concerned”), and 9.5% had concerns about how their child understood language (4.4% “concerned”; 5.1% “a little concerned”). Parents who reported concerns identified “speech not clear to others” as the most frequent area of difficulty (12.0%). Teacher-reported prevalence: 22.3% of children were considered to be less competent than others in their expressive language ability (6.7% “much less competent”; 15.6% “less competent”); 16.9% were considered to be less competent than others in their receptive language ability (4.0% “much less competent”; 12.9% “less competent”). The match between parent and teacher identification was higher for expressive speech and language concern than for receptive language. Direct assessment: 13.0% of children were 1–2 SDs below the mean on the Adapted Peabody Picture Vocabulary Test–III (S. Rothman, 2003), and a further 1.7% were > 2 SDs below the mean. Parent and teacher reports were significantly correlated with scores obtained via direct assessment. Period prevalence: Parents and teachers reported that 14.5% of children had accessed speech-language pathologist (SLP) services. 2.2% indicated that they needed but could not access an SLP.
Conclusion
Multiple indicators of speech and language impairment in diverse contexts confirmed the high prevalence of this condition in early childhood and a concomitant need for SLP services.
This epidemiologic study estimated the prevalence of specific language impairment (SLI) in monolingual English-speaking kindergarten children. From a stratified cluster sample in rural, urban, and suburban areas in the upper midwest, 7,218 children were screened. The language screening failure rate was 26.2%. Children who failed the screening and a similar number of controls were then administered a diagnostic battery (n=2,084) that provided for a diagnosis of SLI using common diagnostic standards. Results provided an estimated overall prevalence rate of 7.4%. The prevalence estimate for boys was 8% and for girls 6%. Variation in prevalence was found among children of different racial/cultural backgrounds; however, these background variables were found to be correlated with parental education, which was also associated with SLI. The parents of 29% of the children identified as SLI reported they had previously been informed that their child had a speech or language problem.
The prevalence estimates obtained fell within recent estimates for SLI, but demonstrated that this condition is more prevalent among females than has been previously reported. Also, the clinical identification of these children remains low among kindergarteners.
This paper reports a longitudinal follow-up of 71 adolescents with a preschool history of speech-language impairment, originally studied by Bishop and Edmundson (1987). These children had been subdivided at 4 years into those with nonverbal IQ 2 SD below the mean (General Delay group), and those with normal nonverbal intelligence (SLI group). At age 5;6 the SLI group was subdivided into those whose language problems had resolved, and those with persistent SLI. The General Delay group was also followed up. At age 15-16 years, these children were compared with age-matched normal-language controls on a battery of tests of spoken language and literacy skills. Children whose language problems had resolved did not differ from controls on tests of vocabulary and language comprehension skills. However, they performed significantly less well on tests of phonological processing and literacy skill. Children who still had significant language difficulties at 5;6 had significant impairments in all aspects of spoken and written language functioning, as did children classified as having a general delay. These children fell further and further behind their peer group in vocabulary growth over time.
The rates of change in the language status of children with language impairment unaccompanied by other developmental or sensory disorders (primary language disorder) were studied in a longitudinal sample of 196 children who were followed from kindergarten through 4th grade. Previous studies have shown that children with such language impairments have moderate rates of improvement during this age range. Also, those with the most specific deficits have the greatest likelihood of improvement. Cole and colleagues have hypothesized that such results could be due to the effect of regression to the mean (K. Cole, I. Schwartz, A. Notari, P. Dale, & P. Mills, 1995). This study used a baseline measure of language that was independent of the measure used for diagnosis in order to control for factors leading to regression to the mean. Patterns of change using the kindergarten diagnostic measure were compared to those using the baseline measure. Rates of diagnostic change between kindergarten and subsequent observation intervals showed patterns of change similar to those of past research. Comparisons using the baseline measure revealed no significant change in relative language status across the 4-year time period. The results showed that when the conditions for regression to the mean were controlled, the poor language of children with language impairments was very likely to persist during the primary school years.
Language impairment (LI) in the preschool years is known to vary over time. Stability in the diagnosis of LI may be influenced by children’s individual variability, the measurement error of commonly used assessment instruments and the cut-points used to define impairment.
To investigate the agreement between two different age-based versions of a language assessment instrument and the stability of the classification of LI using the two measures over a 12-month period.
A total of 945 participants completed the Clinical Evaluation of Language Fundamentals(CELF—Preschool 2 or 4th Edn) at 4 and 5 years of age. Agreement and stability were analysed using Bland–Altman plots, correlation and odds ratios. Sensitivity and specificity were calculated for two thresholds of the CELF-P2 using the diagnostic category on the child’s subsequent CELF-4.
For all CELF scores, mean differences for the cohort between 4 and 5 years were within 1.5 scale score units. In contrast, at the individual level variability was found across the range of scores and was of a greater magnitude than previously reported. Stability in LI classification was low, with 36% of 5-year-olds with LI (defined as a standard score below –1.25) classified as typical at 4 years, even though odds ratios calculated from classifications at the two time points suggested that 4-year-olds with LI had 23 times greater odds than their typical peers to receive a diagnosis of LI at 5 years. The CELF-P2 did not demonstrate adequate levels of diagnostic accuracy for LI at 5 years: sensitivity of 64% and specificity of 92.9%.
Substantial variability across the entire range of possible CELF scores was observed in this community cohort between the ages of 4 and 5 years. The stability of LI classification was lower than that reported in previous research conducted primarily on smaller clinical cohorts. The current study’s results suggest that the variability observed in developmental language pathways is the result of a combination of limitations in measurement instruments, individual children’s abilities and the arbitrary nature of the boundaries defining LI.
Historically speech and language therapy services for children have been framed within a rehabilitative framework with explicit assumptions made about providing therapy to individuals. While this is clearly important in many cases, we argue that this model needs revisiting for a number of reasons. First, our understanding of the nature of disability, and therefore communication disabilities, has changed over the past century. Second, there is an increasing understanding of the impact that the social gradient has on early communication difficulties. Finally, understanding how these factors interact with one other and have an impact across the life course remains poorly understood.
To describe the public health paradigm and explore its implications for speech and language therapy with children.
We test the application of public health methodologies to speech and language therapy services by looking at four dimensions of service delivery: (1) the uptake of services and whether those children who need services receive them; (2) the development of universal prevention services in relation to social disadvantage; (3) the risk of over-interpreting co-morbidity from clinical samples; and (4) the overlap between communicative competence and mental health.
It is concluded that there is a strong case for speech and language therapy services to be reconceptualized to respond to the needs of the whole population and according to socially determined needs, focusing on primary prevention. This is not to disregard individual need, but to highlight the needs of the population as a whole. Although the socio-political context is different between countries, we maintain that this is relevant wherever speech and language therapists have a responsibility for covering whole populations. Finally, we recommend that speech and language therapy services be conceptualized within the framework laid down in The Ottawa Charter for Health Promotion.
Background:
Prospective evidence on psychological outcomes for children with specific language impairments (SLI) is accumulating. To date, there has been no attempt to summarise what this evidence says about the strength of link between SLI and later child and adolescent emotional and behavioural (EB) outcomes.
Methods:
We undertook a systematic review and meta-analysis (following PRISMA guidelines and involving a literature search to June 2012 of seven databases, including MEDLINE and PsychAPA) of prospective, cohort studies of children with SLI and typical language development (TLD) reporting on the incidence and severity of EB problems later in childhood or adolescence.
Results:
Nineteen follow-up reports of eight cohorts with 553 SLI children and 1533 TLD controls were identified. Initial assessment was at 3-8.8 years of age and follow-up duration from 2 to 12 years. Pooled across comparable studies, SLI children were about two times more likely to show disorder levels of overall internalising problems, overall externalising and ADHD problems than TLD children. Compared with the average TLD child (50 percentile), at follow-up, the symptom severity of the average SLI child was at the 72 percentile (95% CI 65-79 percentile) on internalising symptoms, the 69 percentile (95% CI 63-74 percentile) on externalising symptoms and the 60 percentile (95% CI 52-68 percentile) on AHDH severity. The findings about risk to specific mental disorders and the severity of specific problems were inconclusive.
Conclusions:
Relative to typical children, SLI children experience clinically important increases in the severity of diverse emotional, behavioural and ADHD symptoms and more frequently show a clinical level of these problems. The small number of studies included in pooled analysis and methodological heterogeneity reduce the precision and generalisability of the findings. Most studies do not account for initial levels of EB problems.
A large sample of Dunedin (New Zealand) children was assessed at three, five and seven years to study the prevalence and stability of language delay, and to investigate the association between language delay at each age and low intelligence and reading problems at age seven. The prevalence of specific comprehension delay, specific expressive delay, and general language delay varied from 2.0 to 4.3 per cent. General language delays were the most stable. Every type of language delay at each age, particularly earlier, general and stable delay was associated with a significantly higher prevalence of low intelligence or reading difficulties at age seven than among the total sample.
RÉSUMÉ
Etude longitudinale de la prévalence et de la stabilité du retard dévelopmental de langage de deux à sept ans et sa signification dans les scores faibles d'intelligence à sept ans et les difficultés de lecture
Un échantillon important d'enfants de Dunedin, Nouvelle Zélande, a fait l'objet d'examens à trois, cinq et sept ans pour étudier la prévalence et la stabilité du retard de langage sur une période de quatre ans, pour rechercher une association entre le retard de langage à chaque âge et une faible intelligence et des problémes de lecture à sept ans. La prévalence d'un retard spécifique de compréhension, d'un retard spécifique d'expression et d'un retard de langage global variait de 2.0 à 4.3 pour cent; les retards globaux de langage étaient les plus stables. Chaque type de retard de langage pour chaque âge (particuliérement le retard précoce, global et stable) est apparu associéà une prévalence significativement plus élevée d'intelligence faible et de difficulté de lecture à l'âge de sept ans par comparaison avec l'échantillon global.
ZUSAMMENFASSUNG
Eine Kontrollstudie über Prävalenz und Sprachentwicklungsverzögerung im Alter von drei bis sieben Jahren und ihre Bedeutung für schwache Intelligenz und Leseschwäche im Alter von sieben Jahren
Bei einer großen Gruppe von Kindern aus Dunedin (Neu Seeland) wurden Häufigkeit und Persistenz von Sprachverzögerungen über einen Zeitraum von vier Jahren in den Altersstufen drei, fünf und sieben untersucht. Ferner wurde nach einer Beziehung zwischen Sprachverzögerung in jeder Altersstufe, sowie Leseschwäche im Alter von sieben Jahren und schwacher Intelligenz geforscht. Die Häfigkeit bestimmter Verständnis‐und Ausdrucksschwierigkeiten und einer allgemeinen Sprachverzögerung lag zwischen 2.0 und 43 Prozent. Allgemeine Sprachverzögerungen blieben am längsten bestehen. Jede Sprachverzögerung in jeder Altersgruppe (insbesondere sehr frühe, allgemeine und andauernde Sprachverzögerungen) war im Vergleich zur Kontrollgruppe mit einer signifikant höheren Prävalenz von schwacher Intelligenz oder Leseschwäche im Alter von sieben Jahren verbunden.
RESUMEN
Seguimiento de la prevalencia y estabilidad del retraso en el desarrollo del lenguaje de los tres a los siete años de edad y su significado con respecto a la baja inteligencia y dificultades de lectura a los siete años
Una amplia muestra de niños de Dunedin (Nueva Zelanda) fue evaluada a las edades de tres, cinco y siete años de edad para estudiar la prevalencia y estabilidad del retraso del lenguaje a lo largo de un periodo de cuatro años para investigar la asociación entre el retraso en el lenguaje en cada edad y la baja inteligencia y probremas de lectura a la edad de siete años. La prevalencia de un retraso de comprension especifico, de un retraso especifico expresivo y de un retraso general en el lenguaje variaba entre el 2 y el 43 por ciento. Los retrasos generales del lenguaje eran los más estables. Cada tipo de retraso del lenguaje para cada edad (en particular el retraso de lenguaje precoz, general y estable) estaba asociado a una prevalencia signficativamente más alta de baja inteligencia o de dificultades de lectura a la edad de siete años en comparación con la prevalencia de la muestra.
Autism spectrum disorders (ASD) and specific language impairment (SLI) are common developmental disorders characterised by deficits in language and communication. The nature of the relationship between them continues to be a matter of debate. This study investigates whether the co-occurrence of ASD and language impairment is associated with differences in severity or pattern of autistic symptomatology or language profile.
Participants (N = 97) were drawn from a total population cohort of 56,946 screened as part of study to ascertain the prevalence of ASD, aged 9 to 14 years. All children received an ICD-10 clinical diagnosis of ASD or No ASD. Children with nonverbal IQ > or =80 were divided into those with a language impairment (language score of 77 or less) and those without, creating three groups: children with ASD and a language impairment (ALI; N = 41), those with ASD and but no language impairment (ANL; N = 31) and those with language impairment but no ASD (SLI; N = 25).
Children with ALI did not show more current autistic symptoms than those with ANL. Children with SLI were well below the threshold for ASD. Their social adaptation was higher than the ASD groups, but still nearly 2 SD below average. In ALI the combination of ASD and language impairment was associated with weaker functional communication and more severe receptive language difficulties than those found in SLI. Receptive and expressive language were equally impaired in ALI, whereas in SLI receptive language was stronger than expressive.
Co-occurrence of ASD and language impairment is not associated with increased current autistic symptomatology but appears to be associated with greater impairment in receptive language and functional communication.
Using a simple assessment of language and a behaviour screening questionnaire, a one‐in‐four random sample of a total population of three‐year‐olds was screened for the presence of language delay and behaviour problems. A full psycho‐developmental assessment was carried out in children with suspected language delay or a behaviour problem, and in a group of control children, and the sensitivity and specificity of the language screening‐test was examined.
The results showed the importance of investigating language delay in relation to nonverbal abilities. Of those children with a language age less than two‐thirds of their chronological age, 37 per cent also had similarly delayed non‐verbal mental abilities. 50 per cent of the children with a language age of less than 30 months were generally retarded in their non‐verbal abilities. The estimated prevalence of delayed language development is 31 per 1000, of specific language delay 5–7 per 1000, and of severe retardation 4‐2 per 1000. Boys were more likely than girls to have language and general developmental delay.
RÉSUMÉ
Prévalence du retard de langage dans une population d'enfants de trois ans et son association à un retard global
En utilisant une simple appréciation du langage et un questionnaire élémentaire de comportement, un enfant sur quatre de trois dans un échantillon de hasard de la population totale fut identifié avec présence d'un retard de langage et problème de comportement. Une appréciation complète du développement psychomoteur fut alors effectuée chez tous les enfants suspects de retard de langage et de problème de comportement ainsi que sur un groupe contrôle; la sensibilité et la spécificité des tests élémentaires de langage ont été examinées.
Les résultats ont montré l'importance de la relation entre le retard de langage et les aptitudes non verbales. Parmi les enfants ayant un niveau de langage inférieur aux deux tiers de leur age chronologique, 37 pour cent présentaient également un retard des aptitudes mentales non verbales. 50 pour cent des enfants avec un retard de langage de moins de 30 mois étaient globalement retardés dans leurs activités non verbales. La fréquence estimée du retard de langage est de 31 pour mille, d'un retard spécifique de langage de 5,7 pour mille et d'un retard grave de 4,2 pour mille. Les garçons ont plus de chances que les filles de presenter un retard de développement général et de langage.
ZUSAMMENFASSUNG
Häufigkeit einer Sprachverzögerung bei dreijährigen Kindern und ihre Beziehung zu allgemeiner Retardierung
Mit Hilfe eines einfachen Sprachtests und eines Fragebogens zur Beurteilung des Verhaltens wurde in zufälliger Folge eins von vier der dreijährigen Kinder auf Sprachverzögerung und Verhaltensprobleme untersucht. Die Kinder, bei denen eine Sprach‐verzögerung und Verhaltensprobleme vermutet wurden, sowie bei einer Gruppe von Kontrollkindern wurde eine eingehende psychologische Untersuchung durchgeführt. Die Sensitivität und Spezifität des Sprach‐Screening‐Tests wurden untersucht.
Die Ergebnisse zeigten, daß es wichtig ist, die Untersuchung der Sprachverzögerung in Relation zu den nicht verbalen Fähigkeiten zu stellen. Von den Kindern, deren Sprachalter unter zwei Dritteln ihres chronologischen Alters lag, hatten 37 Prozent ebenfalls eine Verzögerung der nicht verbalen Fähigkeiten. 50 Prozent der Kinder mit einem Sprachalter unter 30 Monaten sind im Allgemeinen in ihren nicht verbalen Fähigkeiten retardiert. Die geschätzte Häufigkeit einer verzögerten Sprachentwicklung beträgt 31 von 1000, einer spezifischen Sprachverzögerung 5–7 Prozent von 1000 und einer schweren Retardierung 4‐2 von 1000. Jungen hatten häufiger Sprach‐ und allgemeine Entwicklungsverzögerungen als Mädchen.
RESUMEN
Prevalencia de retraso del lenguaje en una población de niños de tres años de edad y su asociación con retraso general
Utilizando una evaluatión simple del lenguaje y un cuestionario de screening del comportamiento, en la muestra de uno de cada cuatro casos de una población total de tres años de edad se estudió la presencia de un retraso en el lenguaje y problema0073 en el comportamiento.
En los niños con sospecha de un retraso en el lenguaje o de un problema del comporta‐miento y en un grupo de niños control se realizó una valoración de desarrollo psíquico y se examinaron la sensibilidad y especificidad de los tests de screening del lenguaje.
Los resultados mostraron la importancia de investigar el retraso del lenguaje en relatión con habilidades no verbales. En aquellos niños con una edad de lenguaje de menos de los dos tercios con respecto a su edad cronológica, el 37 por ciento tenía también un retraso similar en las habilidades mentales no verbales. El 50 por ciento de los niños con una edad de lenguaje de menos de 30 meses son generalmente retrasados en las habilidades no verbales. La prevalencia estimada del retraso del dessarrollo del lenguaje es 31 por 1000, con retraso en el lenguaje especifico 5,7 por 1000 y de retraso grave 4,2 por 1000. Los muchachos tenían mayor facilidad que las niñas para tener un retraso en el lenguaje y un retraso en el desarrollo general.
Refence centile curves show the distribution of a measurement as it changes according to some covariate, often age. The LMS method summarizes the changing distribution by three curves representing the median, coefficient of variation and skewness, the latter expressed as a Box-Cox power. Using penalized likelihood the three curves can be fitted as cubic splines by non-linear regression, and the extent of smoothing required can be expressed in terms of smoothing parameters or equivalent degrees of freedom. The method is illustrated with data on triceps skinfold in Gambian girls and women, and body weight in U.S.A. girls.
A representative sample of 5-year-old kindergarten children was assessed for speech and/or language disorder. Of the 1,655 children tested, 180 were identified as having speech or language impairment. It is estimated that within the total reference population, between 16.2% and 21.8% would show some impairment; for the boys, the rate would be 15.5% to 20.7% and for the girls, between 19.1% and 25.1%. Most of these children would show some language impairment as opposed to speech problems only. Approximately 36% of the identified boys and 30% of the girls would have speech problems only, the remainder having speech and language problems or language problems only. Followup studies of these children are needed to ascertain their outcome and language status in middle childhood.
A large sample of Dunedin (New Zealand) children was assessed at three, five and seven years to study the prevalence and stability of language delay, and to investigate the association between language delay at each age and low intelligence and reading problems at age seven. The prevalence of specific comprehension delay, specific expressive delay, and general language delay varied from 2.0 to 4.3 per cent. General language delays were the most stable. Every type of language delay at each age, particularly earlier, general and stable delay was associated with a significantly higher prevalence of low intelligence or reading difficulties at age seven than among the total sample.
Concordance rates were compared for 63 monozygotic (MZ) and 27 dizygotic (DZ) same‐sex twin pairs, aged seven years and over, selected because at least one twin met diagnostic criteria for specific speech or language impairment. There was significant heritability for developmental speech and language disorder, defined according to DSM‐III‐R criteria. When the definition of the phenotype was broadened to include those with a past history of disorder and those with a less pronounced discrepancy between verbal and non‐verbal ability, concordance for MZ twins was close to 100 per cent, and that for DZ twins approximately 50 per cent. There was also close similarity between concordant twins for type of disorder. There is good evidence that genetic factors play a role in the aetiology of speech and language impairment; twin data may help us arrive at a clearer conception of the phenotype as well as quantifying the extent of the genetic contribution.
RÉSUMÉ
Bases génétiques des troubles spécifiques de langage: évidence à partir d'une étude de jumeaux
Les taux de concordance ont été compareés entre 63 paires de jumeaux monozygotes et 27 paires dizygotes de même sexe, âgés de sept ans ou plus et sélectionnés du fait que l'un des jumeaux au moins remplissait les critères diagnostiques pour un trouble spécifique de parole ou de langage. II y avail une héritabilité significative pour les troubles développementaux de parole et de langage, scion les critéres du DSM‐III‐R. Quand la définition du phénotype était étendue au cas de troubles passés et à un écart moins prononcé entre capacityés verbales et non verbalcs, la concordance pour les jumeaux monozygotes était proche de 100 pour cent et elle était d'environ 50 pour cent pour les jumeaux dizygotes. 11 y avait également une correspondance étroite entre jumeaux pour le type de troubles. 11 y a done de bonnes raisons pour penser que les facteurs génétiques jouent un rôle dans l'étiologie des troubles de parole et de langage; ces données de jumeaux peuvent nous aider à avoir une conception plus claire du phénotype, aussi bien que des aspects quantifyés de la contribution génétique.
ZUSAMMENFASSUNG
Genetische Grundlage der spezifischen Sprachstörung: Befunde aus einer Zwillingsstudie
Es wurden die Konkordanzraten von 63 monozygoten (MZ) und 27 dizygoten, gleichgeschlechtlichen (DZ) Zwillingspaarcn im Alter von sieben Jahren oder darüber verglichen, die ausgewählt worden waren, weil mindestens ein Zwillingskind die diagnostischen Kriterien für eine spezifische Sprach‐oder Sprachverständnisstörung erfüllte. Es bestand eine signifikante Erblichkeit für die Entwicklung von Sprach‐und Sprachverständnisstörungen, definiert nach den DSM‐III‐R Kriterien. Erweiterte man die Definition des Phänotyps und nahm die mit einer früheren Störung in der Anamnese und die mit einer weniger ausgeprägten Diskrepanz zwischen verbalen und non‐verbalen Fähigkeiten hinzu, war die Konkordanz für MZ Zwillinge nahezu 100 Prozent und die für DZ Zwillinge ungefähr 50 Prozent. Es besteht auch eine weitgehende Übereinstimmung zwischen den konkordanten Zwillingen für die Art der Störung. Es gibt Hinweise, daß genetische Faktoren für die Ätiologie der Sprach‐ und Sprachverständnisstörungen eine Rolle spielen; Zwillingsdaten können dazu beitragen, eine klarere Vorstellung vom Phänotyp zu bekommen, sowie den genetisc