Bishop, D. V. M. (2009). Genes, cognition and communication: insights from neurodevelopmental disorders. The Year in Cognitive Neuroscience: Annals of the New York Academy of Sciences, 1156, 1-18.
NB. THIS FILE TOO BIG TO VIEW ONLINE. You need to save it in order to read it! Chapter on Speech and language difficulties, from 4th edition of Rutter and Taylor: Child and Adolescent Psychiatry, 2002.
Pragmatic language impairment in relation to autism and SLIDorothy Bishop
Bishop DVM. 2000. Pragmatic language impairment: a correlate of SLI, a distinct subgroup, or part of the autistic continuum? In: Bishop DVM, and Leonard LB, eds. Speech and Language Impairments in Children: Causes, Characteristics, Intervention and Outcome. Hove, UK: Psychology Press, 99-113.
Preprint of:
Bishop, D. V. M. (2004). Specific language impairment: diagnostic dilemmas. In L. Verhoeven & H. Van Balkom (Eds.), Classification of Developmental Language Disorders (pp. 309-326). Mahwah, NJ.: Erlbaum.
Bishop, D. V. M. (2009). Genes, cognition and communication: insights from neurodevelopmental disorders. The Year in Cognitive Neuroscience: Annals of the New York Academy of Sciences, 1156, 1-18.
NB. THIS FILE TOO BIG TO VIEW ONLINE. You need to save it in order to read it! Chapter on Speech and language difficulties, from 4th edition of Rutter and Taylor: Child and Adolescent Psychiatry, 2002.
Pragmatic language impairment in relation to autism and SLIDorothy Bishop
Bishop DVM. 2000. Pragmatic language impairment: a correlate of SLI, a distinct subgroup, or part of the autistic continuum? In: Bishop DVM, and Leonard LB, eds. Speech and Language Impairments in Children: Causes, Characteristics, Intervention and Outcome. Hove, UK: Psychology Press, 99-113.
Preprint of:
Bishop, D. V. M. (2004). Specific language impairment: diagnostic dilemmas. In L. Verhoeven & H. Van Balkom (Eds.), Classification of Developmental Language Disorders (pp. 309-326). Mahwah, NJ.: Erlbaum.
Slides to accompany RALLIcampaign YouTube presentation by Professor Dorothy Bishop on Genetics and SLI
A full-length videoed lecture on this topic can be found here:
http://podcasts.ox.ac.uk/languages-disorders-children-what-can-they-tell-us-about-genes-and-brains-video
OR audio version here:
http://podcasts.ox.ac.uk/languages-disorders-children-what-can-they-tell-us-about-genes-and-brains-audio
Reading List 2016; "Why do some children find language so hard to learn?"Dorothy Bishop
Reading list for talk "Why do some children find language so hard to learn?"
Dorothy V. M. Bishop
VIIIth International Conference of Language Acquisition
Palma de Mallorca, Spain
6-9th September
Autism and specific language impairment both involve problems with language and communcation, so how are they distinguished? This slide show accompanies a youtube video for the RALLI campaign.
http://www.youtube.com/rallicampaign
Slides to accompany RALLIcampaign YouTube presentation by Professor Dorothy Bishop on Genetics and SLI
A full-length videoed lecture on this topic can be found here:
http://podcasts.ox.ac.uk/languages-disorders-children-what-can-they-tell-us-about-genes-and-brains-video
OR audio version here:
http://podcasts.ox.ac.uk/languages-disorders-children-what-can-they-tell-us-about-genes-and-brains-audio
Reading List 2016; "Why do some children find language so hard to learn?"Dorothy Bishop
Reading list for talk "Why do some children find language so hard to learn?"
Dorothy V. M. Bishop
VIIIth International Conference of Language Acquisition
Palma de Mallorca, Spain
6-9th September
Autism and specific language impairment both involve problems with language and communcation, so how are they distinguished? This slide show accompanies a youtube video for the RALLI campaign.
http://www.youtube.com/rallicampaign
Slideshow is from the University of Michigan Medical School’s M2 Musculoskeletal sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Muscu
What is a metabolic disease?
Inborn errors of metabolism”
inborn error : an inherited (i.e. genetic) disorder
metabolism : chemical or physical changes in a biological system
ANNOTATIONManagement of childhood stutteringMark Onslow .docxjustine1simpson78276
ANNOTATION
Management of childhood stuttering
Mark Onslow and Sue O’Brian
Australian Stuttering Research Centre, The University of Sydney, Sydney, New South Wales, Australia
Abstract: Stuttering is a speech disorder that begins during the first years of life and is among the most prevalent of developmental disorders.
It appears to be a problem with neural processing of speech involving genetics. Onset typically occurs during the first years of life, shortly after
language development begins. Clinical presentation during childhood is interrupted and effortful speech production, often with rapid onset. If
not corrected during early childhood, it becomes intractable and can cause psychological, social, educational and occupational problems. There
is evidence from replicated clinical trials to support early intervention during the pre-school years. Meta-analysis of studies indicates that children
who receive early intervention during the pre-school years are 7.7 times more likely to have resolution of their stuttering. Early intervention is
recommended with a speech pathologist. Some children who begin to stutter will recover without such intervention. However, the number of
such recoveries is currently not known, and it is not possible to predict which children are likely to recover naturally. Consequently, the current
best practice is for speech pathologists to monitor children for signs of natural recovery for up to 1 year before beginning treatment.
Key words: diagnosis; management; paediatrics; stuttering; treatment.
Stuttering
Stuttering, also known as stammering in the United Kingdom,
is a speech disorder that begins during the first years of life. A
recent community cohort study of 1619 Australian children
recruited at 8 months old found that 8.5% had begun to
stutter by 3 years of age.1 The shape of the cumulative inci-
dence plot suggests that more cases will emerge as the cohort
is studied further. Onset was found to be essentially unpre-
dictable, with only 3.7% of cases explainable with case
history variables such as advanced language development,
twinning and maternal education level. A report of 3 to
17-year-olds derived from the United States National Health
Interview Surveys (n = 95,132) showed stuttering to be the
equal third most prevalent developmental disorder from
among nine, which included attention-deficit/hyperactivity
disorder, autism, cerebral palsy and learning disability.2 The
reported prevalence was 1.6%.
The cause of stuttering is currently unknown; however, brain
imaging data suggest that it involves a problem with neural
processing of speech,3 linked to structural and functional
anomalies at brain sites responsible for spoken language.4,5 As
these anomalies have only been investigated with school chil-
dren and adults, it is unclear whether they are a cause or an
effect of the disorder. There is genetic involvement in stuttering,
with clear evidence of vertical transmission within families.6
Around two th.
specific language impairment is language impairment and delay in children. language has 5 components like morphology, syntax, phonology, semantics and pragmatics. any deficit in these components can lead to specific language impairment.
early intervention for language disorder is always recommended for faster recovery and better outcome results.
#775632 Topic Don Quixote6.1 What Are Speech and Language Imp.docxmayank272369
#775632 Topic: Don Quixote
6.1 What Are Speech and Language Impairments?
Students receive services for SLI more than any other disability except for SLD. This section discusses the difference between a speech impairment and a language impairment. It presents the definition for SLI as outlined by IDEA and discusses the prevalence of SLI in schools in the United States.
Defining SLI
Speech and language impairment (SLI) refers to a group of disorders that affect a student's speech or language skill and development. Language refers to the systems that people use to communicate with each other; it also refers to the meanings of words, and how words are assembled into meaningful thoughts. It can be oral (spoken), written, or even gestural. For example, in the United States, the gestural language of a "high five" usually signals "Congratulations!" Speech, which refers to the oral aspect of language, is how people express ideas or thoughts through sounds. Speech is the main form of communication for people around the world.
A language impairment is a disorder that affects how people understand or use words. This can mean that they have difficulty understanding what people say (receptive language) or that they have difficulty constructing thoughts or ideas (expressive language), or both. Receptive language refers to how people organize and understand information provided through oral, written, or visual means. Expressive language refers to how people construct the words, symbols, or gestures they want to communicate to others. A speech impairment is a disorder that affects the production of sounds and words.
The category of SLI incorporates a wide variety of difficulties, including difficulties related to articulation (pronunciation), fluency (flow of speech), voice, and language (which includes putting words and sentences into meaningful forms). Students with SLI may experience difficulties with speech or language, with approximately half of diagnosed students experiencing both (Seeff-Gabriel, Chiat, & Pring, 2012).
In the field of medicine, SLI often falls under an umbrella category called communication disorders or communicative disorders (as do hearing difficulties; Chapter 10 discusses hearing impairments in detail, as they have their own IDEA 2004 category.) Evaluations or diagnoses from medical professionals may use the term communication disorder, but schools will use the term SLI.
Students with SLI may have academic skills that are below average, average, or above average, but researchers have demonstrated that they often perform below students without SLI on assessments of intelligence, language, and literacy (Ferguson, Hall, Riley, & Moore, 2011). The effects of an SLI on educational outcomes vary and are dependent upon the student's specific difficulties. For some students, the impairments do not hinder learning new material or participating in classroom activities. Other students with SLI, however, have difficulty with working memory ...
6.1 What Are Speech and Language ImpairmentsStudents receive se.docxalinainglis
6.1 What Are Speech and Language Impairments?
Students receive services for SLI more than any other disability except for SLD. This section discusses the difference between a speech impairment and a language impairment. It presents the definition for SLI as outlined by IDEA and discusses the prevalence of SLI in schools in the United States.
Defining SLI
Speech and language impairment (SLI) refers to a group of disorders that affect a student's speech or language skill and development. Language refers to the systems that people use to communicate with each other; it also refers to the meanings of words, and how words are assembled into meaningful thoughts. It can be oral (spoken), written, or even gestural. For example, in the United States, the gestural language of a "high five" usually signals "Congratulations!" Speech, which refers to the oral aspect of language, is how people express ideas or thoughts through sounds. Speech is the main form of communication for people around the world.
A language impairment is a disorder that affects how people understand or use words. This can mean that they have difficulty understanding what people say (receptive language) or that they have difficulty constructing thoughts or ideas (expressive language), or both. Receptive language refers to how people organize and understand information provided through oral, written, or visual means. Expressive language refers to how people construct the words, symbols, or gestures they want to communicate to others. A speech impairment is a disorder that affects the production of sounds and words.
The category of SLI incorporates a wide variety of difficulties, including difficulties related to articulation (pronunciation), fluency (flow of speech), voice, and language (which includes putting words and sentences into meaningful forms). Students with SLI may experience difficulties with speech or language, with approximately half of diagnosed students experiencing both (Seeff-Gabriel, Chiat, & Pring, 2012).
In the field of medicine, SLI often falls under an umbrella category called communication disorders or communicative disorders (as do hearing difficulties; Chapter 10 discusses hearing impairments in detail, as they have their own IDEA 2004 category.) Evaluations or diagnoses from medical professionals may use the term communication disorder, but schools will use the term SLI.
Students with SLI may have academic skills that are below average, average, or above average, but researchers have demonstrated that they often perform below students without SLI on assessments of intelligence, language, and literacy (Ferguson, Hall, Riley, & Moore, 2011). The effects of an SLI on educational outcomes vary and are dependent upon the student's specific difficulties. For some students, the impairments do not hinder learning new material or participating in classroom activities. Other students with SLI, however, have difficulty with working memory, which influences how they .
Speech development- Delay and other problemsBabu Appat
Language is the process whereby we communicate with others. It involves an element of understanding and expression (speech). It is one of the most highly developed of all human skills, giving us a framework for thought and allowing us to communicate. Disorders of speech and language are common, ranging from unclear speech or a slight delay in development to more significant difficulties associated with serious disorders.
10.6 Developmental Disabilities and EducationIn addition to gift.docxhyacinthshackley2629
10.6 Developmental Disabilities and Education
In addition to gifted children and those with more profound intellectual disorders, a significant number of children receive other kinds of special education services. About 6.4 million schoolchildren receive public special education services in the United States. Over 85% are related to behavioral problems (emotional disturbance) and developmental and learning disabilities (National Center for Education Statistics, 2013a). Whereas the numbers of individuals with intellectual disabilities in public schools have declined somewhat over the past two decades, those with emotional disturbances and other developmental disorders have increased dramatically. Like many other disabilities that affect children, the reason for this trend is unknown. Overall, the percentage of children enrolled in special education has increased from 8.3% in 1977 to over 13% currently. As shown in Figure 10.5, enrollment in special education has been dropping gradually since reaching a peak of 13.8% during the 2004–2005 school year.
Figure 10.5: Number of children receiving special education services
Public education services must meet the needs of all children, including those who have special needs.
Source: U.S. Department of Education.
Autism Spectrum Disorder
Early impairments in communication, including speech delays and nonverbal communication (e.g., gestures, eye contact), are characteristic signs of autism spectrum disorder (ASD). Other common markers include fixated interests, repetitive behaviors, and inflexibility over routines. Because of better screening procedures, this developmental disorder can now be identified by 18–24 months of age. A substantial proportion of children with ASD are mute, and many more attain initial language and then lose it. Recent brain imaging has discovered that ASD brains probably process voices and other social stimuli differently beginning at an early age (Grossman, Oberecker, Koch, & Friederici, 2010; Johnson, 2004; Lloyd-Fox, Johnson, & Blasi, 2013).
Courtesy of Ron Mossler
One of the characteristics of Asperger's syndrome is idiosyncratic, or uniquely peculiar, behaviors. In this writing sample from a sixth grader, Trevor refused to skip lines between spelling words. What is only barely visible (in the center of the image) is the smeared paper from Trevor's propensity to press extremely hard on his pencil.
A bit over half of all children with ASD have intellectual disabilities (Centers for Disease Control and Prevention, 2014d). The vast majority have social deficits, too, like skills needed to form friendships or to display empathy (another instance of the interaction of physical, cognitive, and psychosocial domains). Behavioral stereotypes like repetitive rocking or hand flapping that are indicative of ASD are often compared to obsessive-compulsive disorder (OCD). However, people with OCD usually perform rituals (compulsions) in order to experience relief from their thoughts (o.
Open Research Practices in the Age of a Papermill PandemicDorothy Bishop
Talk given to Open Research Group, Maynooth University, October 2022.
Describes the phenomenon of large-scale fraudulent science publishing (papermills), and discusses how open science practices can help tackle this.
Language-impaired preschoolers: A follow-up into adolescence.Dorothy Bishop
Stothard, S. E., Snowling, M. J., Bishop, D. V., Chipchase, B. B., & Kaplan, C. A. (1998). Language-impaired preschoolers: A follow-up into adolescence. Journal of Speech, Language, and Hearing Research: JSLHR, 41(2), 407–418. https://doi.org/10.1044/jslhr.4102.407
ABSTRACT: 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.
Otitis media with effusion: an illustration of ascertainment biasDorothy Bishop
Otitis media with effusion (OME) provides an example of how ascertainment bias can induce spurious correlations. Early work suggested it impacted children's language, but when unbiased samples are studied, the effect is absent or very small
Simulating data to gain insights intopower and p-hackingDorothy Bishop
Very basic introduction to simulating data to illustrate issues affecting reproducibility. Uses Excel and R, but assumes no prior knowledge of R. Please let me know of errors or things that need better explanation.
4 major threats to reproducibility are publication bias, low power, p-hacking and HARKing. In this talk I explain these terms and show how study pre-registration can fix them
Lecture by Prof Dorothy Bishop, 1st Feb 2017, University of Southampton:
What’s wrong with our Universities, and will the Teaching Excellence Framework put it right?
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
State-of-Science Review: Specific Language Impairment
1. DRAFT
Foresight – SR-D1 v1 stage 2
Mental Capital and Mental Wellbeing
Office of Science and Innovation
Version date: 27th April 2007
State-of-Science Review:
Specific Language Impairment
Professor Dorothy Bishop
Department of Experimental Psychology,
University of Oxford
This review has been commissioned as part of the UK Government’s Foresight
project: Mental Capital and Mental Wellbeing. The views expressed do not represent
the policy of any Government or organisation.
Page 1
2. Specific Language Impairment
Abstract
What is Specific Language Impairment (SLI)? Brief account of criteria
used
What causes SLI? Evidence for strong genetic component. Popular
belief that poor language input from parents causes SLI is not
supported by research evidence.
How common is SLI? Will depend on cut-offs used. Clinically significant
problems decline markedly with age
International comparisons. Difficult because of lack of comparable
language measures, and differences in organisation of services.
Educational impact of SLI. High risk of poor literacy and educational
failure in those whose SLI persists to 5 years or beyond.
Impact of SLI on the individual and society. High rates of
unemployment, social isolation and psychiatric disorder.
Can we predict outcome? Age, severity and level of comprehension as
important predictors.
Can we intervene effectively? Woeful lack of good evidence, especially
for older children. Many have persisting difficulties into adulthood
despite intensive intervention. Computerised intervention worth
exploring but has not so far fulfilled early promise.
Future trends. Prevalence likely to be stable. Emphasis on early years
intervention only cost-effective if we identify those whose problems are
likely to persist. Need for controlled trials of intervention. Need for
proactive approach to identifying niches in society for people who lack
language skills.
What is Specific Language Impairment (SLI)?
SLI is diagnosed when a child’s language fails to develop along normal
lines for no obvious reason: hearing loss, physical disability, emotional
disturbance, parental neglect and brain injury are all ruled out before
the diagnosis is made. The child is developing normally in areas other
than language, and will show adequate intelligence if tested using
nonverbal measures (e.g. construction puzzles; reasoning tasks with
shapes).
Most people have heard of dyslexia and autism, but not SLI. This
illustrates the power of labels: SLI is far more common than autism,
and has close commonalities with dyslexia, but it does not have a
catchy medical-sounding label, so it is neglected.
The manifestations of SLI are variable both in terms of severity and
quality: in some children, the main difficulties are a delay in starting to
talk, with immature language persisting into school age. For other
children, problems in understanding language predominate: they may
take in only one or two words of a complex sentence such as “if you
bring your swimsuit tomorrow, we can go to the pool after lunch.”
Page 2
3. Vocabulary is usually limited in SLI, and children may have problems
understanding unusual or abstract terms.
It is likely that the term SLI is an umbrella term for a range of distinct
disorders, but as yet there is no agreement about subtypes.
A brief film featuring two young people with speech and language
problems, Stephen and Graham, can be found on
http://www.ican.org.uk/
What causes SLI?
30 years ago, it was often assumed that SLI was the consequence of
poor parenting. This view was reinforced as recently as 2003 in a
speech by Alan Wells, Director of the Basic Skills Agency, who
maintained that many families do not converse with their children, and
use instead a "daily grunt”
(http://news.bbc.co.uk/1/hi/education/2638889.stm). In fact, language
development in children appears remarkably resilient in the face of
limited language input: perhaps the clearest evidence comes from
normally-hearing children who are raised by parents who are
profoundly deaf and unable to converse intelligibly. In most cases,
these children learn to talk normally, provided they are exposed to a
small amount of normal language (Schiff-Myers, 1988).
Although other factors, such as chronic middle ear disease (which
causes a mild and fluctuating hearing loss) may play a role in SLI, it is
now generally accepted that this condition is not usually associated
with hearing difficulties (Roberts et al., 2004), and is a strongly genetic
disorder (Bishop, 2006). The best evidence comes from studies of
twins. Two twins growing up together are exposed to the same home
environment, yet may differ radically in their language skills. Such
different outcomes are, however, seen almost exclusively in fraternal
(non-identical) twins, who are genetically different. Identical twins share
the same genes and tend to be much more similar in language ability.
There can be some variation in the severity and persistence of SLI in
identical twins, indicating that environmental factors affect the course of
disorder, but it is unusual to find a child with SLI who has an identical
twin with normal language.
Although twin studies indicate genes are important, SLI is not usually
caused by a mutation in a single gene. Current evidence suggests that
there are many different genes that can influence language learning,
and SLI results when a child inherits a particularly detrimental
combination of risk factors (Bishop, 2006).
Parents of children with SLI have similar genetic makeup and may well
have limited language skills themselves. We need to beware of
assuming that a parent with poor language has caused their child’s
problems because of lack of stimulation.
How common is SLI?
There is no sharp dividing line between SLI and normality: children vary
in their language abilities, and the frequency of SLI will therefore
Page 3
4. depend on how stringently it is defined. An epidemiological study in the
US identified around 7.4% of 5-year-olds as having SLI (Tomblin et al.,
1997), based on an initial screening test followed by a more detailed
language assessment, but they noted that this figure could rise or fall
depending on the cutoffs used to define impairment.
An alternative way of estimating the scale of the problem is to consider
the proportion of children referred for speech and language therapy:
however, this does not give a satisfactory prevalence estimate,
because it will depend on resources. Furthermore, problems with
speech production and expressive language are more readily identified
than poor language comprehension, but the latter has a worse
prognosis (Zhang & Tomblin, 2000). In the study by Tomblin et al.
(1997), in only 29% of cases had parents been informed previously that
the child had speech and language problems.
The media occasionally run stories about an “epidemic” of language
impairment in children starting school, sometimes attributing it to
working parents, TV, and so on. There is no hard evidence of any
secular change in prevalence of language difficulties. It is likely that
perception of problems is inflated by the fact that more children are
starting school at 4 years of age, and our large cities now include
unprecedented numbers of children who do not have English as a first
language. It would be well worth instituting an epidemiological study to
monitor rates of language impairment (and related disorders), every 10
years or so, using standard methods of assessment, to estimate the
true scale of the problem, and identify any secular trends.
International comparisons
It is not possible to compare SLI in the UK with other countries. Part of
the problem is that language assessments used to identify SLI may not
work in translation, and can only be interpreted if we have adequate
norms (i.e., data on a large representative population of children, that
allow us to quantify typical performance at different ages). In many
countries such data do not exist. Furthermore, even in English-
speaking countries, there are difficulties in making international
comparisons, because tests may be culturally specific.
There is a fascinating research literature comparing manifestations of
SLI in different languages, but this is primarily of interest to those
working on theoretical conceptualisations of the disorder (Leonard,
2000).
Educational impact of SLI
Numerous studies have demonstrated that children with SLI are at high
risk of educational failure. Low levels of literacy are common, even in
children who receive specialist help, and educational attainments are
typically poor (e.g. Catts et al., 2002; Snowling et al., 2001). This bleak
picture is especially applicable to children who have language
impairments that persist beyond the age of 5 years, and where
comprehension as well as expressive language is affected. For
instance, Simkin and Conti-Ramsden (2006) found that 67% of children
Page 4
5. with expressive SLI and 88% of those with receptive SLI had serious
reading difficulties at 11 years of age.
Impact of SLI on the individual and society
SLI is associated with a high rate of psychiatric disorder (see review by
Cohen, 2001). For instance, Conti-Ramsden and Botting (2004) found
that 64% of a sample of 11-year-olds with SLI scored above a clinical
threshold on a questionnaire for psychiatric difficulties, and 36% were
regularly bullied, compared with 12% of comparison children. The
greatest risk appears to be for attentional problems and social
difficulties, rather than conduct or emotional disorders. Looked at from
the other direction, a study of children attending psychiatric clinics
found that 28% had hitherto undetected language difficulties that were
moderate or severe (Cohen et al., 1998). The reason for this
association is not fully understood. An obvious mechanism is via stress
induced by social rejection and isolation, both of which are common in
children with language difficulties. In addition, a child with poor
language skills may fail to use internalised language as a method of
self-regulation, e.g. talking oneself through past events or future plans,
or instructing oneself to behave in a particular way. It is also possible
that the same genes that influence language learning lead directly to
psychiatric vulnerability.
There are a few studies of the long-term outcome of children with SLI,
and they mostly make depressing reading. There are elevated rates of
unemployment, social isolation and psychiatric disorder (Clegg et al.,
2005). However, most studies focused on outcomes of those with
severe problems, where comprehension as well as expressive
language is affected. Better outcomes were seen for children who had
milder difficulties and did not require special educational provision
(Snowling, et al., 2006). Where language difficulties had resolved by 5
years of age, there was no excess psychopathology.
Can we predict outcome?
Longitudinal studies of young children with SLI generally agree that
long-term outcome is worse in those who have more severe problems
(e.g. Stothard et al.,1998). Severity can be measured both in terms of
the level of performance on a given language measure, and the range
of language functions that are affected.
Age is also critical. Understandably, there is much interest in identifying
children as young as possible, on the grounds that early intervention is
likely to be more effective than late. However, the situation is
complicated by the fact that many children make good spontaneous
progress after a late start in language. There have been several studies
of ‘late-talkers’, identified at age 18-24 months because they are
producing very few words. Most such children appear to be late
bloomers, in that their outcome is similar to that of other children when
followed up into middle childhood (Paul, 2000). A key factor appears to
be comprehension level: those who have poor understanding of what
others say are less likely to spontaneously catch up. However, the
Page 5
6. evidence base for this claim is slender, as few studies have looked
specifically at comprehension in young children.
One can also see spontaneous recovery between 4 and 5 years of age,
especially in children whose problems are predominantly with
expressive language. One UK study studied children who had specific
speech and language problems at 4 years of age; they were seen at
4.5 yr, 5.5 yr, 8 yr and 15 yr. Around 40% had essentially normalised
by 5.5 years, and their long-term outcome was generally good,
although minor literacy problems were found in some (Stothard et al,
1998). However, the 60% who still had measurable language problems
at 5.5 years fared much worse, with the gap between them and other
children widening as time went by. For the most severely affected
children, it was not uncommon to see a drop in nonverbal intelligence
in adolescence, as well as stagnation of language skills.
Can we intervene effectively?
It would be a mistake to imagine that findings on genetics of SLI
preclude the development of effective interventions. What the genetics
studies tell us is that the kinds of variations in environment that most
children experience do not play a salient role in determining who has a
language problem. Thus, simply talking more to these children is
unlikely to improve their language skills. But the genetic findings do not
preclude the development of interventions tailored specifically to the
child’s problems that could be effective. By analogy, we know that
diabetes has a genetic basis, but we do not conclude the condition is
untreatable: rather, we devise treatments that are outside the normal
range of experience to tackle the underlying cause.
Children with SLI will normally receive therapy from a Speech and
Language Therapist (SALT). In more severe cases, the child may
receive special educational provision, either in a specialist class in a
mainstream school, or in a special school.
Unfortunately, there has been little research on efficacy of interventions
for SLI (Law et al, 2004). Such evidence as exists suggests
intervention can be effective for improving intelligibility in children with
speech impairments, but there is a lack of good research on
interventions for language impairments, particularly with older children.
In the UK, there are a number of special schools that have developed
skills in working with older children with SLI over many years, but this
knowledge is fragmented and not widely available, and there are no
well-controlled studies of efficacy.
One problem for intervention studies is that one is often looking for an
effect of intervention that may be superimposed on spontaneous
improvement. SALTs regard early intervention as important, and some
local authorities focus all their resources on preschoolers, and have no
provision for school-aged children. This strategy is no doubt reinforced
by the fact that many preschoolers who receive therapy make excellent
progress. The point that is often missed is that many of these children
would have done well with no intervention. For example, in one
controlled study of early intervention there was no difference between
Page 6
7. treated and untreated children, not because nobody improved, but
because everyone improved (Stevenson et al., 1982). Clearly we do
not want to wait to intervene with those children who are at risk for
long-term problems, but it is important to use research evidence on
predictors to focus intervention those children who are unlikely to
improve spontaneously.
One relatively new advance has been development of computerised
interventions for SLI. The best-known of these is FastForword® (FFW),
which was developed out of research showing that children with SLI
have problems in processing sounds that are brief or rapid (Tallal et al.,
1996). The idea behind FFW is that the brain can be trained to
perceive increasingly small differences between sounds. Children play
computerised games that adjust the level of difficulty of discrimination
to the child’s performance level. The games involve both language
stimuli (e.g. child determines whether a spoken sentence matches a
pictured scenario) and nonlinguistic sounds (e.g. glides that resemble
animal sounds, and vary in speed of change). The originators of FFW
have won scientific accolades for what appeared at first to be a
researcher’s Holy Grail – an intervention developed out of basic
neuroscience that would help children. Unfortunately, later evaluations
have found that FFW has not fulfilled its early promise, and appears to
do no better than conventional speech and language therapy (e.g.,
Cohen et al., 2005). This is surprising, given that the intervention is so
intensive, requiring the child to spend 90-100 minutes per day on the
program for around 6 weeks. Although school boards in the US have
bought into the program (in some cases for all pupils, not just those
with SLI), there is growing scepticism as to whether this is justified,
given the high financial cost of the program, and the time the child has
to spend away from regular school activities (Troia & Whitney, 2003).
An editorial in Nature Neuroscience (January 2004) expressed concern
that this kind of educational program is being marketed without the
evidence for efficacy that would be required for a drug treatment.
A final point to stress about early intervention concerns the link
between SLI and poor literacy. Children in UK schools are introduced
to literacy at ever earlier ages. In this regard, the UK is very different
from our European neighbours, where children are often not introduced
to literacy until 6 or even 7 years of age; rather, they education focuses
on language-based activities that build the skills needed for successful
reading and writing. The available evidence suggests that this late start
does not lead to literacy problems, though comparisons are
complicated by the different orthographies of different languages
(Lundberg & Linnakylä, 1993). Evidence from children with SLI
suggests that those who fail in literacy are children who are exposed to
literacy instruction when relevant linguistic skills are still
underdeveloped (Bird et al., 1995). It is possible that children would do
better if literacy instruction were delayed until they had been shown to
have a critical level of linguistic skill.
Ideally we need studies of efficacy that adopt the methods of
randomised controlled trials as used in mainstream medicine. These
are expensive and can run into difficulty because of the reluctance of
Page 7
8. many SALTs to have an untreated control group. They argue this is
unethical; however, it could equally be argued that that it is unethical to
persist in using interventions of unproven efficacy, especially when
resources are limited. Unfortunately, it is impossible to do a cost-
effectiveness analysis of interventions for SLI because we lack
information on efficacy, both for improving SLI and for preventing other
adverse outcomes.
Future trends
The prevalence of SLI is likely to remain stable over the years, but its
impact could become more serious, as our society becomes
increasingly dependent on literacy skills.
Intervention currently focuses on the early years – from as early as 18
months in some cases, and up to around 4 years of age. This focus,
though understandable, may be non-optimal, because of high levels of
spontaneous improvement. One way forward would be to combine
early intervention with use of using predictors from test results to
identify those whose problems are unlikely to resolve spontaneously.
It would be worth conducting a controlled trial to consider whether
children’s literacy skills can be enhanced by deferring literacy training
until a minimal level of language competence has been attained.
Computerised intervention has generated great excitement, because it
has the potential to deliver thousands of events to a child in a game-
like format, thereby maintaining motivation, and adapting on-line to the
child’s responses. Although attempts to develop computerised
programs for treating SLI have, as yet, not been shown to be effective,
we have as yet barely explored the potential of this approach. More
research is needed to identify the conditions under which children with
SLI can learn most effectively.
We should not underestimate the difficulty of remediating SLI: we may
need to accept that some children will never be competent
communicators. If so, then putting all our efforts into working to improve
their language skills may be as futile as trying to train a blind child to
see. For many children, education can be a dispiriting experience
characterised by continual failure. We should continue to do research
to identify barriers to language learning in these children so we can
develop more effective interventions, but this should not be at the
expense of other areas of development. It would be desirable to identify
for a child with SLI a non-linguistic skill in which they could succeed,
and to devote time on the curriculum to fostering this. These children
could also benefit from prophylactic intervention designed to avoid the
associated social problems: thus intervention with them would go
beyond the narrow remit of improving language skills, to work also to
enhance their ability to make friendships and find a role in the wider
world. The modern world is increasingly hostile to those who lack skills
in literacy, communication and computer processing: it may be
necessary to take a more proactive approach to identifying niches for
people who lack these skills.
Page 8
9. Conventional speech and language therapy has evolved in response to
a clinical need, and is not an exact science. We need to ensure that
clinical skills that are developed in specialist centres are preserved and
disseminated. More use of video-links between specialist centres and
mainstream schools could be helpful. Specific educational methods
also need formal evaluation, so we can identify the most effective
approaches.
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