Emma Knox

Follow-up of children attending infant language units: outcomes at 11 years of age

A large cohort of 242 children who had been attending infants language units at 7 years of age was followed up when the children were in their final year of primary school. Two hundred (83%) of the children were reassessed at 11 years of age on a wide battery of language and literacy measures, on a test of non-verbal ability, an autism checklist and a communication checklist. In total, 89% of children still scored < 1 SD from the mean on at least one test of language and the majority (63%) scored poorly on three or more assessments demonstrating widespread difficulties. Compared with non-verbal abilities at 7 years of age, a large proportion of the cohort also performed poorly on performance IQ subtests (28%). A further 10 children scored highly on a checklist for autistic spectrum disorder. Thus, only 115 (58%) children could be said to meet criteria for specific language impairment. A small group of 16 children appeared to have entirely resolved their difficulties. These outcomes and their implications for education and long-term impact of the disorder are discussed.

Specific language impairment and school outcomes. I: Identifying and explaining variability at the end of compulsory education

BACKGROUND This investigation reports the results of national educational examinations in secondary schooling for young people who have been participating in the Manchester Language Study. AIMS The emphasis of the study is on furthering understanding of educational outcomes at the end of compulsory education. METHODS & PROCEDURES A total of 120 adolescents with a history of specific language impairment (SLI) and 121 adolescents with typical development (TD) who were in their final year of compulsory secondary schooling (mean age = 17;4 years) participated. National educational examination results throughout secondary schooling were collected along with a range of psycholinguistic skills from 11 to 16/17 years. OUTCOMES & RESULTS Forty-four per cent of young people with SLI obtained at least one of the expected qualifications at the end of secondary education, indicating some improvements compared with reports on earlier cohorts. Regression analyses revealed that literacy and language skills were predictive of educational attainment after controlling for IQ and maternal education. Nearly one-quarter of the sample of adolescents with SLI was not entered for any examinations at the end of compulsory education. A very strong association between earlier patterns of entry for examinations and patterns of examination entry at school leaving age was found. CONCLUSIONS In addition to performance IQ, concurrent and early literacy and language skills have significant effects on the academic attainments of young people with a history of SLI. The transition from primary to secondary schooling is a crucial time for assessment and evaluation of individual childrens needs and levels of support required.

Bullying risks of 11-year-old children with specific language impairment (SLI): does school placement matter?

In addressing an issue rarely explored in research literature, the prevalence and severity of the risk of being bullied at school was measured in 100 children with specific language impairment (SLI). Participants attended a range of different educational placement types and these were compared for bullying risk. Furthermore, the risk encountered by children with SLI was compared with that of normally developing age-matched peers. Each participant completed a questionnaire and it was found that 36% of participants with SLI considered themselves at risk of being bullied in school compared with only 12% of the normally developing cohort. No statistically significant difference was found between the risk experienced by participants with SLI attending mainstream education and that by participants attending special education placements. Possible explanations for the results are offered and the relevance of the findings in the context of optimizing the educational experience of children with SLI is highlighted.

Predicting pathways of specific language impairment: what differentiates good and poor outcome?

A group of 117 children who met criteria for Specific Language Impairment (SLI) at 7 years of age were reassessed at 11 years of age. The data gathered from both stages were used to identify predictors of good and poor outcome from earlier test assessments. Results of logistic regressions indicated that measures of narrative retelling skills and expressive syntax were the strongest predictors of overall prognosis. This finding persisted when a nonverbal measure was included as a predictor alongside language measures in the regression model. There was found to be a lack of independent predictive contribution of early measures of articulation to later overall prognosis. Demographic factors (maternal education and family income) were not differently distributed across outcome groups. The theoretical and practical implications of the findings are discussed.

Educational attainments of children with specific language impairment at year 6

The present study examined the performance of a group of children with Specific Language Impairment (SLI) in National Curriculum Key Stage 2 (KS2) assessments of key curricular subjects. One hundred children (86 boys and 14 girls), who previously had all been in full-time attendance at specialist provision in the form of language units, participated in the study. The sample of participants were recruited in their final year of primary school education (year 6) and were divided into two groups, matched for ability, defined by the nature of their current educational placement. The Mainstream Education group comprised 50 children attending mainstream education with or without some level of additional support. The Special Education group consisted of 50 children attending special education in the form of either a language unit, a language school, or a special school. Participants’ performance in the National Curriculum KS2 assessments was measured, together with an examination of assessment procedures concerning the application of special testing arrangements. It was found that participants performed poorly relative to national levels of expectation and achievement across the curricular subjects of English, mathematics and science in both KS2 tests and teacher assessments. The Mainstream Education group of participants was found to perform significantly better than the Special Education group in the mathematics and science tests. Furthermore, special arrangements were made for a large number of participants who did take the tests.

Focus on Practice: Educational placements and National Curriculum Key Stage 2 test outcomes of children with a history of specific language impairment

As part of their longitudinal investigations of a large cohort with a history of specific language impairment (SLI), Professor Gina Conti-Ramsden and her research team based at the School of Education, University of Manchester, Dr Emma Knox, Dr Nicola Botting and Dr Zoe Simkin report on the changing educational placements and National Curriculum assessment outcomes of 200 children at 11 years. Teacher questionnaires reporting on the Year 6 primary education placements of the sample reveal details about the long-term educational needs of children with SLI. Furthermore, in exploring the experiences of the sample in the National Curriculum Key Stage 2 tests the present study found that children with SLI perform poorly relative to national expectations of levels of achievement across all tests. At present there are no guidelines for supporting children with SLI in relation to National Curriculum tests and the present data suggests there is an obvious need for these to be developed.

Different school placements following language unit attendance: Which factors affect language outcome?

The study compared the outcomes of two groups of children who were attending language unit provision at 7 years of age. Of 242 children in the original study, 62 (28%) transferred to mainstream school placements at age 8 years. These children were then closely matched to children still attending language unit provision at this age using measures of non-verbal IQ, expression and comprehension. These two groups of children were compared on outcome at 11 years in the areas of language skill, non-verbal IQ and social behaviour. Teacher/speech-language therapist opinions of placement were also examined as factors affecting outcome. Results show that children who moved to mainstream provision at 8 years were more likely to be attending mainstream at 11 years, although the majority received extra support. No further differences were evident in outcome according to placement type. However, there was a main effect of teacher/therapist opinion on outcome--children whose teachers were not entirely happy with the 8-year placement performed more poorly at 11 years on language measures. There were no differences on any other measures. The findings suggest that follow-on placements for children attending language units need to be more closely in line with teachers opinions and that more flexibility needs to be evident in school placement policy in order that appropriate educational settings can be arranged.

The benefit of minocycline on negative symptoms of schizophrenia in patients with recent-onset psychosis (BeneMin): a randomised, double-blind, placebo-controlled trial

Summary Background The antibiotic minocycline has neuroprotective and anti-inflammatory properties that could prevent or reverse progressive neuropathic changes implicated in recent-onset schizophrenia. In the BeneMin study, we aimed to replicate the benefit of minocycline on negative symptoms reported in previous pilot studies, and to understand the mechanisms involved. Methods In this randomised, double-blind, placebo-controlled trial, we recruited people with a schizophrenia-spectrum disorder that had begun within the past 5 years with continuing positive symptoms from 12 National Health Service (NHS) trusts. Participants were randomly assigned according to an automated permuted blocks algorithm, stratified by pharmacy, to receive minocycline (200 mg per day for 2 weeks, then 300 mg per day for the remainder of the 12-month study period) or matching placebo, which were added to their continuing treatment. The primary clinical outcome was the negative symptom subscale score of the Positive and Negative Syndrome Scales (PANSS) across follow-ups at months 2, 6, 9, and 12. The primary biomarker outcomes were medial prefrontal grey-matter volume, dorsolateral prefrontal cortex activation during a working memory task, and plasma concentration of interleukin 6. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN49141214, and the EU Clinical Trials register (EudraCT) number is 2010-022463-35I. Findings Between April 16, 2013, and April 30, 2015, we recruited 207 people and randomly assigned them to receive minocycline (n=104) or placebo (n=103). Compared with placebo, the addition of minocycline had no effect on ratings of negative symptoms (treatment effect difference −0·19, 95% CI −1·23 to 0·85; p=0·73). The primary biomarker outcomes did not change over time and were not affected by minocycline. The groups did not differ in the rate of serious adverse events (n=11 in placebo group and n=18 in the minocycline group), which were mostly due to admissions for worsening psychiatric state (n=10 in the placebo group and n=15 in the minocycline group). The most common adverse events were gastrointestinal (n=12 in the placebo group, n=19 in the minocycline group), psychiatric (n=16 in placebo group, n=8 in minocycline group), nervous system (n=8 in the placebo group, n=12 in the minocycline group), and dermatological (n=10 in the placebo group, n=8 in the minocycline group). Interpretation Minocycline does not benefit negative or other symptoms of schizophrenia over and above adherence to routine clinical care in first-episode psychosis. There was no evidence of a persistent progressive neuropathic or inflammatory process underpinning negative symptoms. Further trials of minocycline in early psychosis are not warranted until there is clear evidence of an inflammatory process, such as microgliosis, against which minocycline has known efficacy. Funding National Institute for Health Research Efficacy and Mechanism Evaluation (EME) programme, an MRC and NIHR partnership.

T86. COGNITIVE SUBTYPES IN FIRST-EPISODE PSYCHOSIS: AN EMPIRICAL LONGITUDINAL STUDY OF RELATIONSHIP TO COGNITIVE, SYMPTOM AND FUNCTIONAL OUTCOMES

Abstract Background Variable outcomes following a first-episode of psychosis are partly attributable to heterogeneity in cognitive functioning. Previous work in first episode psychosis has identified clinically meaningful cognitive sub-types based on pre-specified differences in estimated premorbid and current cognitive functioning. We used an empirical clustering technique to examine whether these cognitive profiles can be replicated with an unbiased method, their relationship with clinical, cognitive and global functioning at psychosis onset as well as their stability over time. Methods Patients attending NHS early intervention services following a first episode of psychosis were recruited to a double-blind clinical trial of minocycline for negative symptoms of psychosis (BeneMin) which found no treatment effect. Participants were assessed on clinical, cognitive and global functioning at baseline (n=169) and 12-month follow-up (n=107). K-means analysis was used to empirically cluster participants on the basis of estimated premorbid IQ (WTAR), and baseline cognitive functioning (derived from 4 sub-tests of the WAIS IV, verbal fluency (COWAT) and verbal learning scores (AVLT)). Clinical and global functioning was assessed using the Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale (CDS) and Global Assessment of Functioning (GAF). Results K-means cluster analysis revealed three cognitive subgroups: 28% showing preserved premorbid and current IQ (PIQ); 29% displaying compromised premorbid and current IQ (CIQ); and 43% with normal premorbid but deteriorated current IQ (DIQ). There were no significant differences between groups in age, gender, CDS, cannabis use or olanzapine equivalent antipsychotic dose. The PIQ group performed significantly better than the DIQ group on all baseline cognitive measures, who performed significantly better than the CIQ group. At baseline, there were significant differences in GAF scores (F(2,168) = 4.267, p=0.016; PIQ >DIQ, LIQ). At 12-months, all three groups had improved over time on cognitive function with no group x time interactions except verbal fluency (F(2, 97) = 5.204,p=0.007) where only the DIQ group improved. All groups improved on positive and total symptom scores but only the PIQ and DIQ groups significantly improved on negative and general symptom scales. There was no significant change in GAF score in any of the groups over time. At follow-up there were significant differences between groups in negative syndrome scores (F(2, 104) = 8.720, p=0.004: LIQ > PIQ, DIQ) and global functioning (F(2,101) = 5.880 p=0.004; PIQ > DIQ, LIQ). Discussion Using an unbiased method to define cognitive subgroups at first episode, we confirmed in a new sample, previous findings which used pre-specified criteria. A large subgroup showed evidence of a decline in IQ at psychosis onset and 12-months later this subgroup had neither continued to deteriorate nor returned to premorbid levels of cognition. Patients with preserved normal and compromised cognitive function at psychosis onset showed no deterioration over 12 months. The cognitive sub-groupings were clinically meaningful. The preserved group showed better general function which persisted over 12 months. General functional outcome in the IQ decline group was as poor as the compromised group and the compromised group had more persistent negative symptoms.