Prevalence and persistence of language disorder in a population - - PowerPoint PPT Presentation

Prevalence and persistence of language disorder in a population study

Professor Courtenay Norbury Psychology and Language Sciences, UCL April 2018, Afasic Cymru

the SCALES teams

Andrew Pickles Gillian Baird Tony Charman Emily Simonoff 2012-2013 Claire Corser, Becca Lucas, Tanya Hayman, Charlotte Wray, Naomi Swain, Charlotte Nason, Debbie Gooch, Hayley White Debbie Gooch George Vamvakas 2014-2015 Katie Whiteside, Charlotte Wray, Claire Corser, Natalie Kenney, Caroline Bird, Harriet Maydew 2018-2019 Jessica Banks, Laura Lucas, Sarah Griffiths, Lydia Yeomans Sarah Griffiths

Developmental Language Disorder

• child’s language abilities are below chronological age expectations
• language deficits are not explained by other developmental concerns such

as sensory impairment, autism, extreme deprivation, head injury, intellectual impairment

• language impairments interfere with everyday life at home or at school

DSM-5 (APA, 2013)

role of non-verbal abilities in Developmental Language Disorder

• Non-verbal ability single most common

reason children refused access to specialist speech-language therapy or placement in language units in the UK (Dockrell et al. 2006)

• Yet non-verbal ability key risk factor for

persistent & severe language disorder (Bishop & Edmundson, 1987; Conti- Ramsden et al. 2012)

• CATALISE recommend removal of non-

verbal abilities in criteria for diagnosis or treatment/provision decisions

• SCALES – investigate the impact of

relaxing non-verbal criteria on prevalence and progress

SCALES: a population study

• Population: 7267 children starting

mainstream school in 2011 (59% of total) (180 schools in total)

• Gender: 51% boys and 49% girls
• Ethnicity: 5959 children (82%) of white

British ethnic origin (83% England; 83% Surrey)

• English as additional language: 797

(11%) were rated as having English as an additional language (17% UK total; 10% Surrey)

• Socio-economic status: Income

Deprivation Affecting Children Index (IDACI) – skewed towards more affluent families, but we have a huge range!

KEY QUESTIONS:

• How many children start

school with language disorder?

• What other

developmental concerns are present?

• How do these co-
• ccurring deficits change
• ver time?

Stage 1: teacher report

Short form of CCC-2

Measure of social, emotional, behaviour skills Measure of language & communication Measure of development/ attainment

teacher report of language

1% No Phrase Speech

Children’s Communication Checklist –Short 14% of total pop

• younger children rated as having more language difficulties, behaviour problems and

poorer academic progress

• mismatch between language abilities of 4-year-olds and curriculum demands
• fewer than 5% of those with teacher-rated language difficulties achieved “Good Level of

Development” on the EYFSP

• language best predictor of academic attainment
• significant associations between language and social, emotional, behavioural problems

from end of reception year MY VIEW: FOCUS EARLY YEARS CURRICULUM ON DEVELOPING ORAL LANGUAGE!

in-depth assessment of language

• 529 children assessed in Year 1

(83% in 150 schools)

• 499 children assessed in Year 3

(94% of Year 1 cohort, in 180 schools)

Below 7th centile

• n 2/5 composites

in-depth assessment of language

Prevalence Year 1

% of population Developmental Language Disorder (cause unknown) 7.58% higher NVIQ 4.80% lower NVIQ 2.78% Gender (boys:girls) 1.22:1 Language Disorder (known cause and/or intellectual impairment) 2.34%

Functional impact:

• Increased rates of

social, emotional, behavioural problems

• ~10% achieve

early curriculum targets

Low non-verbal

(3rd – 15th centile)

High non- verbal

(normal range)

Lang Disorder & other concerns

IDACI rank 17987 17770 18923 Communication checklist 19.61 18.06 25.24 Language composite (z-score, -1 = 16th centile)

• 1.88
• 1.60
• 2.16

% Social, emotional, behavioural probs 9.38 9.85 51.36 EYFSP 27.20 28.32 25.79 % referred to SLT 52.05 31.50 66.00

stability in language ability Year 1 – Year 3

• 4
• 2

2

• 4
• 2

2 4 3 z_total_comp y

Total Language Year 1 (z-score) Total Language Year 3 (z-score) Better than Year 1 Worse than Year 1

ICC = .95

• individual change/development on a particular

characteristic over time

4 years 11 years

Gr Growth: children change and develop

• maintain position within a distribution on a particular characteristic
• ver time

4 years 11 years

St Stabil ilit ity: yet children stay the same

There is real improvement in language (raw scores)!

Not only is this group improving, growth RATE is similar to TD peers

Narrowing the gap is challenging!

• LD groups must learn

language faster than the TD group

• Is this possible?
• Is there a critical

period?

• Is current provision

sufficient to do it?

2 year language gap

• Biological limits?
• Change in language

input/learning environment?

• Nature of the

language to be learned?

Future predictions for language growth

TD DLD LD

Key recommendations:

time language ability TD DLD

• Ensure those with persistent language disorder have a

functional level of language/communication/literacy

• Receive EXTRA support at vulnerable transition periods
• Success measures include non-language/academic outcome

measures (e.g. mental health)

pre-school literacy transition to secondary transition to work/adult life Efforts to close gap before school

entry

SCALES 2

Children with DLD become adolescents and adults with DLD…

Poor literacy unemployment Problems with peer relationships Increased risk poor mental health

Key priority: mitigate risk of adverse outcomes

in other developmental areas

SCALES 2

• Revisiting participants in Year 6

and again at Year 8

• Monitoring changing language

trajectories

• How does rate of growth change

when inputs change?

• Measuring self/other-reported

symptoms of attention, social problems, anxiety, depression, and emotional problems

• Direct measures of emotion

recognition and emotion regulation

Temporal distancing: how will this event that is unpleasant now affect you in the future?

Surrey County Council Virginia & Jennifer! Cheryl, Katherine & Barbara

Teachers, SENCOs and all school staff for their enthusiastic support

The many, many children and their families, who have enriched my life and taught me so much

https://www.youtube.com/RADLD http://www.lilac-lab.org c.norbury@ucl.ac.uk

thank you for listening!