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 Sarah Griffiths Andrew Pickles Emily Simonoff Tony Charman Gillian Baird Debbie Gooch George Vamvakas 2012-2013 2014-2015 2018-2019 Claire Corser, Becca Lucas, Tanya Katie Whiteside, Charlotte Wray, Jessica Banks, Laura Lucas, Hayman, Charlotte Wray, Naomi Claire Corser, Natalie Kenney, Sarah Griffiths, Lydia Yeomans Swain, Charlotte Nason, Debbie Caroline Bird, Harriet Maydew Gooch, Hayley White
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 KEY QUESTIONS: • Ethnicity : 5959 children (82%) of white • How many children start British ethnic origin (83% England; 83% Surrey) school with language • English as additional language : 797 disorder? (11%) were rated as having English as an • What other additional language (17% UK total; 10% Surrey) developmental concerns • Socio-economic status: Income are present? Deprivation Affecting Children Index • How do these co- (IDACI) – skewed towards more affluent occurring deficits change families, but we have a huge range! over time?
Stage 1: teacher report Short form of CCC-2 Measure of Measure of social, development/ emotional, Measure of attainment behaviour skills language & communication
teacher report of language 14% of total pop 1% No Phrase Speech Children’s Communication Checklist – Short
• 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 7 th centile on 2/5 composites
in-depth assessment of language % of Prevalence Year 1 population Functional impact: Developmental Language Disorder 7.58% • Increased rates of (cause unknown) social, emotional, higher NVIQ 4.80% behavioural problems lower NVIQ 2.78% • ~10% achieve Gender (boys:girls) 1.22:1 early curriculum Language Disorder (known cause 2.34% targets and/or intellectual impairment)
Low non-verbal High non- Lang Disorder (3 rd – 15 th centile) verbal & other (normal range) concerns IDACI rank 17987 17770 18923 Communication 19.61 18.06 25.24 checklist Language composite -1.88 -1.60 -2.16 (z-score, -1 = 16 th centile) % Social, emotional, 9.38 9.85 51.36 behavioural probs EYFSP 27.20 28.32 25.79 % referred to SLT 52.05 31.50 66.00
stability in language ability Year 1 – Year 3 2 Better than Year 1 Total Language Year 3 (z-score) 0 -2 Worse than Year 1 -4 -4 -2 0 2 4 ICC = .95 3 z_total_comp y Total Language Year 1 (z-score)
Gr Growth: children change and develop • individual change/development on a particular characteristic over time 4 years 11 years
St Stabil ilit ity: yet children stay the same • maintain position within a distribution on a particular characteristic over time 4 years 11 years
There is real improvement in language (raw scores)! Narrowing the gap is 2 year language gap challenging! • LD groups must learn language faster than the TD group • Is this possible? • Is there a critical Not only is period? this group improving, • Is current provision growth RATE sufficient to do it? is similar to TD peers
Future predictions for language growth TD DLD LD • Biological limits? • Change in language input/learning environment? • Nature of the language to be learned?
Key recommendations: Efforts to TD close gap DLD before school language entry ability transition to transition to pre-school literacy secondary work/adult life time • 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)
SCALES 2 Poor literacy Children with DLD become adolescents and adults with DLD… unemployment Increased risk poor mental health Problems with peer relationships 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 The many, many children and their Teachers, SENCOs and all school staff families, who have for their enriched my life and enthusiastic taught me so much support
thank you for listening! https://www.youtube.com/RADLD http://www.lilac-lab.org c.norbury@ucl.ac.uk
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