Emotional and Behavioural Outcomes Later in Childhood and Adolescence for Children with Specific Language Impairments: Meta-Analyses of Controlled Prospective Studies.
01 May 2013-Journal of Child Psychology and Psychiatry (John Wiley & Sons, Ltd)-Vol. 54, Iss: 5, pp 516-524
TL;DR: Compared 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.
Abstract: 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.
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TL;DR: At school entry, approximately two children in every class of 30 pupils will experience language disorder severe enough to hinder academic progress, and access to specialist clinical services should not depend on NVIQ.
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.
504 citations
TL;DR: Findings from two longitudinal studies suggest that language ability may be a useful target for the prevention or even treatment of attention deficits and EXT problems in children.
Abstract: Prior studies have suggested, but not fully established, that language ability is important for regulating attention and behavior. Language ability may have implications for understanding attention-deficit hyperactivity disorder (ADHD) and conduct disorders, as well as subclinical problems. This article reports findings from two longitudinal studies to test (a) whether language ability has an independent effect on behavior problems, and (b) the direction of effect between language ability and behavior problems. In Study 1 (N = 585), language ability was measured annually from ages 7 to 13 years by language subtests of standardized academic achievement tests administered at the children's schools. Inattentive-hyperactive (I-H) and externalizing (EXT) problems were reported annually by teachers and mothers. In Study 2 (N = 11,506), language ability (receptive vocabulary) and mother-rated I-H and EXT problems were measured biannually from ages 4 to 12 years. Analyses in both studies showed that language ability predicted within-individual variability in the development of I-H and EXT problems over and above the effects of sex, ethnicity, socioeconomic status (SES), and performance in other academic and intellectual domains (e.g., math, reading comprehension, reading recognition, and short-term memory [STM]). Even after controls for prior levels of behavior problems, language ability predicted later behavior problems more strongly than behavior problems predicted later language ability, suggesting that the direction of effect may be from language ability to behavior problems. The findings suggest that language ability may be a useful target for the prevention or even treatment of attention deficits and EXT problems in children.
179 citations
TL;DR: Adolescents with SLI report having more difficulties with peers and having more mental health problems than do typical adolescents, and most adolescents see themselves as prosocial.
156 citations
Cites background or result from "Emotional and Behavioural Outcomes ..."
...A recent meta-analysis indicates that young people with SLI are two times more likely to exhibit abnormal levels of emotional and behavioral difficulties than their typically developing (TD) peers (Goh & O’Kearney, 2012)....
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...First, as expected from previous research findings (Goh & O’Kearney, 2012; Im-Bolter & Cohen, 2007; Toppelberg & Shapiro, 2000), adolescents with a history of SLI reported more behavioral difficulties, more emotional symptoms, and more difficulties with peer relations than did their TD peers....
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...There is some preliminary evidence that being a male adolescent with SLI is associated with conduct problems (Brownlie et al., 2004; Goh & O’Kearney, 2012)....
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TL;DR: At the group level, young people with a history of DLD more commonly have less skilled employment and more rarely achieve professional roles, and at the individual level there is considerable variation with smaller but not trivial proportions of young adults with a History of D LD showing good educational and employment outcomes.
Abstract: Background: Developmental language disorder (DLD) presents a considerable barrier for young adults to engage in further education and training. Early studies with young adults with DLD revealed poor educational achievement and lack of opportunities to progress in education. More recent studies have provided more positive findings. Relatively sparse data exist, however, on current cohorts and the factors that predict outcomes.
Aims: To examine educational and employment outcomes in young adulthood in a sample of people with histories of DLD, compared with an age-matched peer group without DLD. We ask: How do educational pathways and early jobs compare between those with and without DLD? Are young adults with DLD receiving similar levels of income as their peers? To what extent are language and literacy abilities associated with outcomes?
Methods & Procedures: Participants included 84 individuals with DLD (67% males) and 88 age-matched peers without DLD (56% males). Participants were on average 24 years of age. They completed a battery of psycholinguistic, literacy and nonverbal skills assessments. Data were also collected on educational qualifications, current educational status, extent of educational support received, employment status, history and support, as well as current income.
Outcomes & Results: Those with DLD obtained lower academic and vocational qualifications. Higher educational/vocational qualifications were associated with better language, better reading and higher PIQ. There were few differences between the two groups in terms of engagement with education but the mean age at leaving education was significantly earlier in the participants with DLD. Substantially more participants with DLD reported receiving support or dispensation from their educational institution. There was no significant difference between groups in the proportion of young people currently employed, though a higher proportion of the age-matched peers was in work full-time. Participants with DLD were much more likely to be in non-professional occupations. However, when examining pay in relation to types of occupation, the groups’ incomes were broadly comparable.
Conclusions & Implications: At the group level, young people with a history of DLD more commonly have less skilled employment and more rarely achieve professional roles. At the individual level, there is considerable variation with smaller but not trivial proportions of young adults with a history of DLD showing good educational and employment outcomes. There are positive aspects to early adult outcomes for some young people with a history of DLD.
132 citations
Cites background from "Emotional and Behavioural Outcomes ..."
...…a decline in nonverbal functioning over childhood to adolescence (Conti-Ramsden et al. 2012), and social and psychiatric difficulties in childhood and adolescence (Beitchman et al. 2001, Conti-Ramsden and Botting 2004, Conti-Ramsden et al. 2013, 2016, St Clair et al. 2011, Yew and O’Kearney 2013)....
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TL;DR: A conceptual model that distinguishes deprivation and threat as distinct forms of childhood adversity with different pathways to psychopathology is tested and suggests that unique developmental mechanisms link different forms of adversity with psychopathology.
Abstract: Prior research demonstrates a link between exposure to childhood adversity and psychopathology later in development. However, work on mechanisms linking adversity to psychopathology fails to account for specificity in these pathways across different types of adversity. Here, we test a conceptual model that distinguishes deprivation and threat as distinct forms of childhood adversity with different pathways to psychopathology. Deprivation involves an absence of inputs from the environment, such as cognitive and social stimulation, that influence psychopathology by altering cognitive development, such as verbal abilities. Threat includes experiences involving harm or threat of harm that increase risk for psychopathology through disruptions in social-emotional processing. We test the prediction that deprivation, but not threat, increases risk for psychopathology through altered verbal abilities. Data were drawn from the Child Development Project (N = 585), which followed children for over a decade. We analyze data from assessment points at age 5, 6, 14, and 17 years. Mothers completed interviews at age 5 and 6 on exposure to threat and deprivation experiences. Youth verbal abilities were assessed at age 14. At age 17, mothers reported on child psychopathology. A path analysis model tested longitudinal paths to internalizing and externalizing problems from experiences of deprivation and threat. Consistent with predictions, deprivation was associated with risk for externalizing problems via effects on verbal abilities at age 14. Threat was associated longitudinally with both internalizing and externalizing problems, but these effects were not mediated by verbal abilities. Results suggest that unique developmental mechanisms link different forms of adversity with psychopathology. (PsycINFO Database Record
116 citations
Cites background from "Emotional and Behavioural Outcomes ..."
...Lower verbal abilities also predict increased risk for internalizing problems in middle childhood and early adolescence (Bornstein, Hahn, & Suwalsky, 2013; Salmon, O’Kearney, Reese, & Fortune, 2016; Yew & O’Kearney, 2013)....
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References
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01 Jan 2014
TL;DR: The Newcastle-Ottawa Scale (NOS) as discussed by the authors was developed to assess the quality of nonrandomised studies with its design, content and ease of use directed to the task of incorporating the quality assessments in the interpretation of meta-analytic results.
Abstract: Nonrandomised studies, including case-control and cohort studies, can be challenging to implement and conduct. Assessment of the quality of such studies is essential for a proper understanding of nonrandomised studies. The Newcastle-Ottawa Scale (NOS) is an ongoing collaboration between the Universities of Newcastle, Australia and Ottawa, Canada. It was developed to assess the quality of nonrandomised studies with its design, content and ease of use directed to the task of incorporating the quality assessments in the interpretation of meta-analytic results. A 'star system' has been developed in which a study is judged on three broad perspectives: the selection of the study groups; the comparability of the groups; and the ascertainment of either the exposure or outcome of interest for case-control or cohort studies respectively. The goal of this project is to develop an instrument providing an easy and convenient tool for quality assessment of nonrandomised studies to be used in a systematic review.
17,590 citations
TL;DR: The meaning and rationale for each checklist item is explained, and an example of good reporting is included and, where possible, references to relevant empirical studies and methodological literature are included.
Abstract: Systematic reviews and meta-analyses are essential to summarise evidence relating to efficacy and safety of healthcare interventions accurately and reliably. The clarity and transparency of these reports, however, are not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (quality of reporting of meta-analysis) statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realising these issues, an international group that included experienced authors and methodologists developed PRISMA (preferred reporting items for systematic reviews and meta-analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this explanation and elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA statement, this document, and the associated website (www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
13,813 citations
TL;DR: 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.
Abstract: 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 ...
1,932 citations
TL;DR: The authors discuss the value of confidence intervals, show how they could be used in addition to or instead of retrospective power analysis, and demonstrate that confidence intervals can convey information more effectively in some situations than power analyses alone.
Abstract: In this article, the authors outline methods for using fixed and random effects power analysis in the context of meta-analysis. Like statistical power analysis for primary studies, power analysis for meta-analysis can be done either prospectively or retrospectively and requires assumptions about parameters that are unknown. The authors provide some suggestions for thinking about these parameters, in particular for the random effects variance component. The authors also show how the typically uninformative retrospective power analysis can be made more informative. The authors then discuss the value of confidence intervals, show how they could be used in addition to or instead of retrospective power analysis, and also demonstrate that confidence intervals can convey information more effectively in some situations than power analyses alone. Finally, the authors take up the question “How many studies do you need to do a meta-analysis?” and show that, given the need for a conclusion, the answer is “two studies...
853 citations
TL;DR: A receptive developmental language disorder involves significant deficits in theory of mind, verbal short-term memory and phonological processing, together with substantial social adaptation difficulties and increased risk of psychiatric disorder in adult life.
Abstract: Background: Little is known on the adult outcome and longitudinal trajectory of childhood developmental language disorders (DLD) and on the prognostic predictors.
Method: Seventeen men with a severe receptive DLD in childhood, reassessed in middle childhood and early adult life, were studied again in their mid-thirties with tests of intelligence (IQ), language, literacy, theory of mind and memory together with assessments of psychosocial outcome. They were compared with the non language disordered siblings of the DLD cohort to control for shared family background, adults matched to the DLD cohort on age and performance IQ (IQM group) and a cohort from the National Child Development Study (NCDS) matched to the DLD cohort on childhood IQ and social class.
Results: The DLD men had normal intelligence with higher performance IQ than verbal IQ, a severe and persisting language disorder, severe literacy impairments and significant deficits in theory of mind and phonological processing. Within the DLD cohort higher childhood intelligence and language were associated with superior cognitive and language ability at final adult outcome. In their mid-thirties, the DLD cohort had significantly worse social adaptation (with prolonged unemployment and a paucity of close friendships and love relationships) compared with both their siblings and NCDS controls. Self-reports showed a higher rate of schizotypal features but not affective disorder. Four DLD adults had serious mental health problems (two had developed schizophrenia).
Conclusion: A receptive developmental language disorder involves significant deficits in theory of mind, verbal short-term memory and phonological processing, together with substantial social adaptation difficulties and increased risk of psychiatric disorder in adult life. The theoretical and clinical implications of the findings are discussed.
545 citations