Juliane Cuperus

Pragmatic Language Impairment and Associated Behavioural Problems.

BACKGROUND Specific language impairment (SLI) is diagnosed when a child shows isolated structural language problems. The diagnosis of pragmatic language impairment (PLI) is given to children who show difficulties with the use of language in context. Unlike children with SLI, these children tend to show relatively intact structural language skills while they do exhibit clear communicative deficits. There is hardly any research on the relationship between pragmatic competence and behavioural problems. Existing research suggests a strong relationship, but has only been executed on clinical SLI samples. Moreover, it is not known whether pragmatic language problems are related to specific types of behavioural problems. AIMS This study aims to clarify the incidence and nature of behavioural problems in children with PLI using a prognostic design in mainstream education. This design should provide valuable insights into the general relationship between PLI and various behavioural problems. METHODS & PROCEDURES Teachers completed the Childrens Communication Checklist (CCC) and the Strengths and Difficulties Questionnaire (SDQ) and provided additional data for a sample of 1364 children aged 4 years. OUTCOMES & RESULTS Within the community sample, pragmatic competence is highly correlated with behavioural problems. Pragmatic competence is a good predictor of behavioural problems, and once pragmatic competence is accounted for, structural language abilities do not predict behavioural problems. Children with pragmatic language impairment often show behavioural problems, largely of an externalizing nature. The most prominent problems are hyperactivity and the lack of prosocial behaviour, which reach clinical levels for this group. However, all problem levels are elevated compared with normally developing children. CONCLUSIONS & IMPLICATIONS Young children with PLI show a wide variety of behavioural problems. Early assessment of pragmatic competence may benefit early detection of children at risk of behavioural problems. Furthermore, due to the relationship between pragmatic competence, behavioural problems and possible underlying disorders such as autism and attention-deficit hyperactivity disorder (ADHD), early assessment of pragmatic competence may also provide an early marker for the detection of autism or ADHD.

Working memory performance and executive function behaviors in young children with SLI

The present study compared the performances of young children with specific language impairment (SLI) to that of typically developing (TD) children on cognitive measures of working memory (WM) and behavioral ratings of executive functions (EF). The Automated Working Memory Assessment was administered to 58 children with SLI and 58 TD children aged 4 and 5 years. Additionally, parents completed the Behavior Rating Inventory of Executive Function - Preschool Version. The results showed the SLI group to perform significantly worse than the TD group on both cognitive and behavioral measures of WM. The deficits in WM performance were not restricted to the verbal domain, but also affected visuospatial WM. The deficits in EF behaviors included problems with inhibition, shifting, emotional control, and planning/organization. The patterns of associations between WM performance and EF behaviors differed for the SLI versus TD groups. WM performance significantly discriminated between young children with SLI and TD, with 89% of the children classified correctly. The data indicate domain general impairments in WM and problems in EF behaviors in young children with SLI. Attention should thus be paid to WM - both verbal and visuospatial - and EF in clinical practice. Implications for assessment and remediation were discussed.

Visuospatial working memory in specific language impairment: A meta-analysis

We conducted a meta-analysis of the data from studies comparing visuospatial working memory (WM) in children with specific language impairment (SLI) and typically developing (TD) children. The effect sizes of 21 studies (including 32 visuospatial storage tasks and 9 visuospatial central executive (CE) tasks) were identified via computerized database searches and the reference sections of the identified studies. Meta-analyses and moderator analyses were conducted to examine the magnitude of the differences in visuospatial storage and CE, and their relation to the inclusion criteria used for SLI and the age of the children. The results showed significant effect sizes for visuospatial storage (d=0.49) and visuospatial CE (d=0.63), indicating deficits in both components of visuospatial WM in children with SLI. The moderator analyses showed that greater impairment in visuospatial storage was associated with more pervasive language impairment, whereas age was not significant associated with visuospatial WM. The finding of deficits in visuospatial WM suggests domain-general impairments in children with SLI. It raises questions about the language-specificity of a diagnosis of SLI. Careful attention should thus be paid to both verbal and visuospatial WM in clinical practice, and especially in those children with pervasive language impairments.

Screening for pragmatic language impairment: The potential of the children's communication checklist

The present study examines the validity of the Dutch Childrens Communication Checklist (CCC) for children in kindergarten in a community sample, in order to assess the feasibility of using it as a screening instrument in the general population. Teachers completed the CCC for a representative sample of 1396 children at kindergarten level, taken from 53 primary schools in The Netherlands. The CCC was also completed for a clinical group consisting of children with SLI in special education. Reliability as measured with internal consistency scores was found to be good for the community sample. With regard to the construct validity, a five-factor second-order factor model was found when the pragmatic subscales were analysed, which provided a reasonable fit. Criterion validity as measured using the concordance between the CCC and teacher opinions was moderate. The children identified by the CCC as having Pragmatic Language Impairment (defined as scoring below the cut off of 132) were often characterized by the teachers as having social-emotional problems, language problems or combined problems. Comparison with a clinical SLI sample showed the pragmatically impaired children in the community sample to have a profile similar to that of the clinical group of children with PLI in special education. The main difference was visible in structural language problems, which were less severe for the PLI group in mainstream education. The results of this study suggest that screening for PLI is indeed possible using the CCC.

Narrative competence and underlying mechanisms in children with pragmatic language impairment

This study investigated narrative competence in children with pragmatic language impairment (PLI) and the extent to which it is related to impairments in theory of mind and executive functioning (EF). Narrative competence was assessed using a retelling design in a group of 77 children with PLI and a control group of 77 typically developing children, aged 5. The children with PLI showed an overall poorer narrative competence as apparent in measures of narrative productivity, organization of content, and cohesion. Some of these differences could be attributed to language impairments. The remaining differences could be partly interpreted as pragmatic deficits. In typically developing children, narrative productivity skills were related to both theory of mind and EF, but only theory of mind explained unique variance once language ability was added to the model. In the PLI group, however, narrative productivity skills were solely related to EF, over and above language abilities. Organization of story content and cohesion were not related to any of the cognitive measures for either group. The results indicate that children with PLI show narrative deficits and that these deficits are related to EF.

Dynamics of the Theory of Mind construct: A developmental perspective

Theory of Mind (ToM) encompasses a wide variety of abilities, which develop during childhood. However, to date most ToM research has focused on the single concept of false-belief understanding, and examined ToM only in young children. Furthermore, there is a lack of implementation of a longitudinal design, which examines the dynamics of the ToM construct over several years. Our longitudinal study measured the abilities of a group of 5-year-old children (n = 77) in mainstream education during three consecutive years, on aspects of ToM related to emotion understanding and false-belief understanding. The results provide support for significant improvements in emotion understanding and false-belief understanding between the ages of 5 and 7. Whereas emotion attribution was already largely developed at age 5, more intricate aspects of emotion understanding, such as understanding display rules and understanding mixed emotions showed significant developments. Over the course of the years, children also showed an increasing awareness of false-belief understanding. In addition to the developmental growth, the different ToM aspects were found to be relatively stable over time. Correlations as well as predictive relations between emotion understanding and false-belief understanding could be identified. Finally, there was evidence for the role of language ability in the development of the ToM aspects under consideration. The results support the notion that ToM abilities measured at age 5 are not just a snapshot but provide a longer-term outlook as well.

Interactions between working memory and language in young children with specific language impairment (SLI)

The underlying structure of working memory (WM) in young children with and without specific language impairment (SLI) was examined. The associations between the components of WM and the language abilities of young children with SLI were then analyzed. The Automated Working Memory Assessment and four linguistic tasks were administered to 58 children with SLI and 58 children without SLI, aged 4–5 years. The WM of the children was best represented by a model with four separate but interacting components of verbal storage, visuospatial storage, verbal central executive (CE), and visuospatial CE. The associations between the four components of WM did not differ significantly for the two groups of children. However, the individual components of WM showed varying associations with the language abilities of the children with SLI. The verbal CE component of WM was moderately to strongly associated with all the language abilities in children with SLI: receptive vocabulary, expressive vocabulary, verbal comprehension, and syntactic development. These results show verbal CE to be involved in a wide range of linguistic skills; the limited ability of young children with SLI to simultaneously store and process verbal information may constrain their acquisition of linguistic skills. Attention should thus be paid to the language problems of children with SLI, but also to the WM impairments that can contribute to their language problems.

Executive function behaviours in children with specific language impairment (SLI)

Abstract Background: There is growing evidence that linguistic and non-linguistic factors may contribute to the problems associated with specific language impairment (SLI). One factor that has been implicated is executive functioning (EF). Most studies investigating EF in children with SLI use performance based tasks. Significant group differences in children with SLI are reported on the following components of EF: inhibition, working memory, planning and fluency, although not on the ‘shifting’ component. Correlations between performance based measurements of EF and ratings of everyday EF behaviours are often low. It is possible that standardised tests are not sufficiently sensitive to the multidimensional nature of EF. Therefore it is suggested that information on EF should be collected in different contexts and from different sources using behavioural ratings, like the Behaviour Rating Inventory of Executive Function (BRIEF) for children. Methods and procedures: A clinical sample of 237 school aged children, aged 5–12 years, (157 boys, 80 girls) with SLI participated in this study. Behavioural and cognitive measures of EF were administered: the BRIEF-questionnaire, assessing everyday EF behaviour in a home and school setting and two EF tasks: Digit span (WISC-III-NL) and Creature Counting (TEA-Ch). Outcomes and results: Compared to the normative sample the prevalence of EF problems in school in children with SLI is much higher than in the normal population. Teachers reported significantly more problems on almost all EF domains (i.e. Inhibition, Shifting, Emotional control, Initiate, Working memory, Plan/organise, and Monitor), except organisation of materials. Working memory and Initiate are the most impaired, since more than one third of the children had scores in the clinical range on these scales. Compared to the normative sample parents scored significantly more working memory problems. MANOVA-analyses showed developmental and gender differences on EF behaviour in school. Overall, older children had less problems in EF behaviours than younger children and boys showed more problems than girls. Like others we found low correlations between behavioural and cognitive measures (r = 0·20). Conclusions: School aged children with SLI show substantial impairments in everyday EF behaviour in a classroom setting. Almost one third of the children scored in the clinical range on the Metacognition Index. Our findings replicate low correlations between performance based and behavioural based measures on EF. These findings indicate the importance of expanding EF assessment with behavioural measures in clinical practice for children with SLI.

Developmental Associations Between Working Memory and Language in Children With Specific Language Impairment: A Longitudinal Study

Purpose This longitudinal study examined differences in the development of working memory (WM) between children with specific language impairment (SLI) and typically developing (TD) children. Further, it explored to what extent language at ages 7-8 years could be predicted by measures of language and/or WM at ages 4-5 years. Method Thirty children with SLI and 33 TD children who were previously examined on measures of WM and language at ages 4-5 years (T1) were reexamined at ages 7-8 years (T2). Results The developmental course of WM was mostly similar for the two groups; only the development of the verbal storage component differed. At T1, children with SLI performed significantly below their TD peers on all components of WM (verbal storage, verbal central executive [CE], visuospatial storage, and visuospatial CE), whereas at T2, the differences for the visuospatial components were no longer significant when age and intelligence were taken into account. Hierarchical regression showed language and verbal CE at T1 to be significant predictors of language at T2, with no differences in the developmental associations between language and WM for the two groups. Conclusions The results of this study suggest that particularly verbal CE is of importance for the acquisition of linguistic skills.

Executive function training in children with SLI: A pilot study

The aim of this study was to evaluate the effectiveness of a computer-based executive function (EF) training in children with specific language impairment (SLI). Ten children with SLI, ages 8 to 12 years, completed a 25-session training of visuospatial working memory, inhibition and cognitive flexibility over a 6-week period. Treatment outcome was examined directly after training and at 6 months follow-up by tasks of the three trained EF, tasks of untrained neurocognitive functions (verbal working memory, attention, planning and fluency), and ratings of EF and behavioral problems by parents and teachers. Directly after training, results showed significant improvement on cognitive flexibility and a positive trend for visuospatial storage and inhibition. At 6 months follow-up, the children performed significantly better on tasks of all three trained EFs. Furthermore, the results showed significant improvement on sustained attention, attention control, parent- and teacher-rated attention behavior and parent-rated EF and externalizing behavior with medium effect sizes. The results of this pilot study highlight the importance of a large-scale, randomized controlled trial examining the possible effects of EF training in children with SLI.