Penny Roy

Institutional Care: Risk from Family Background or Pattern of Rearing?

Previous research has shown that children receiving substitute parental care tend to have high rates of emotional/behavioural disturbance, but uncertainty remains on the extent to which this derives from genetic risk, adverse experiences before receiving substitute care, or from risks associated with substitute care experiences. In order to examine the effects of institutional rearing (as a specific form of substitute care), two groups of primary school children reared in substitute care from before the age of 12 months were compared: 19 children in residential group (institutional) care and 19 in continuous stable foster family care (matched for age and gender). The two groups were similar in coming from biological families with high rates of psychopathology and social malfunctioning, but differed with respect to pattern of rearing. Both groups were compared with classroom controls, using teacher questionnaires, systematic classroom observations, and standardised cognitive testing. Parental questionnaires were also obtained for the two substitute care groups. As found previously, the combined substitute care groups differed from controls in showing a high level of hyperactivity/inattention. The observational measures showed a similar effect, indicating that the elevated rate was not attributable to rater bias. The teacher questionnaire and observational measures showed, however, that the increased level of hyperactivity/ inattention was substantially higher in the institutional group than the foster family group. Parental questionnaire ratings showed the same contrast between the groups, except that the main difference was on unsociability and emotional disturbance rather than hyperactivity/ inattention. It is concluded that, against a background of genetic and early environmental risk, institutional rearing predisposes to a pattern of hyperactivity/inattention.

Psychological distress after stroke and aphasia: the first six months

Objective: We explored the factors that predicted psychological distress in the first six months post stroke in a sample including people with aphasia. Design: Prospective longitudinal observational study. Setting and subjects: Participants with a first stroke from two acute stroke units were assessed while still in hospital (baseline) and at three and six months post stroke. Main measures: Distress was assessed with the General Health Questionnaire-12. Other measures included: NIH Stroke Scale, Barthel Index, Frenchay Aphasia Screening Test, Frenchay Activities Index, MOS Social Support Scale and social network indicators. Logistic regression was used to identify predictors of distress at each stage post stroke; and to determine what baseline factors predicted distress at six months. Results: Eighty-seven participants were able to self-report on measures used, of whom 32 (37%) had aphasia. 71 (82%) were seen at six months, including 11 (16%) with aphasia. Predictors of distress were: stroke severity at baseline; low social support at three months; and loneliness and low satisfaction with social network at six months. The baseline factors that predicted distress at six months were psychological distress, loneliness and low satisfaction with social network (Nagelkerke R2 = 0.49). Aphasia was not a predictor of distress at any time point. Yet, at three months post stroke 93% of those with aphasia experienced high distress, as opposed to 50% of those without aphasia (χ2 (1) = 8.61, P<0.01). Conclusions: Factors contributing to distress after stroke vary across time. Loneliness and low satisfaction with one’s social network are particularly important and contribute to long-term psychological distress.

Early phonological and sociocognitive skills as predictors of later language and social communication outcomes.

BACKGROUND Previous studies of outcome for children with early language delay have focused on measures of early language as predictors of language outcome. This study investigates whether very early processing skills (VEPS) known to underpin language development will be better predictors of specific language and social communication outcomes than measures of language itself. METHOD Participants were 163 children referred to clinical services with concerns about language at 2;6-3;6 years and followed up at 4-5 years. Novel assessments of phonological and sociocognitive processing were administered at Time 1 (T1), together with a standardised test of receptive and expressive language, and parental report of expressive vocabulary. The language test was re-administered at Time 2 (T2), together with assessments of morphosyntax and parental reports of social communication. RESULTS Intercorrelations at and between T1 and T2 were high, and dissociations were rare. Ordinal regressions were run, entering predictors singly and simultaneously. With the exception of the phonological task, every early measure on its own was significantly predictive of most outcomes, and receptive language was the strongest all-round predictor. Results of simultaneous entry, controlling for the effect of other predictors, showed that early language was the strongest predictor of general language outcome, but early phonology was the strongest predictor of a measure of morphosyntax, and early sociocognition the strongest predictor of social communication. CONCLUSIONS Language measures which draw on a wide range of skills were the strongest overall predictors of general language outcomes. However, our VEPS measures were stronger predictors of specific outcomes. The clinical and theoretical implications of these findings are discussed.

Predictors of health-related quality of life (HRQL) in people with chronic aphasia

Background: In recent years, quality of life measures have been used increasingly to evaluate the effectiveness of services or interventions. For people with chronic disabilities, research has focused on identifying the main predictors of their health-related quality of life (HRQL), in order to address the issue of how to meet their needs in rehabilitation in a more holistic way. Aims: This study assessed the main predictors of HRQL in people with chronic aphasia following stroke. We investigated the relationship between HRQL and various demographic and stroke-related variables and other variables that have been associated with HRQL in stroke survivors (e.g., emotional distress, daily activities, social support). Methods: A cross-sectional design was adopted. A cluster sampling framework was used to recruit participants with chronic aphasia (> 1 year) from three different sites. Questionnaires and assessments on the different variables were administered to all participants by a speech and language therapist, in an interview format. Multiple regression analysis was used to assess what were the main predictors of HRQL in people with aphasia. Results: Of 95 participants, 83 (87%) were able to self-report on all the assessments. Emotional distress, involvement in home and outdoors activities, extent of communication disability, and number of comorbid conditions explained 52% of the variance in HRQL (adjusted R 2 = .52). Stroke type (infarct vs haemorrhage), time post-onset, and demographic variables (gender, ethnicity, marital status, employment status, and socioeconomic status) were not significantly associated with HRQL in these participants. Conclusions: Increased distress, reduced involvement in activities, increased communication disability, and comorbidity predict poorer HRQL in people with chronic aphasia after stroke. Service providers need to take these factors into account when designing intervention programmes.

Treating children with expressive phonological disorders: does phonological awareness therapy work in the clinic?

BACKGROUND Recent research has shown that phonological awareness therapy can improve speech production in children with expressive phonological disorders. This approach may be appealing to clinicians as the therapy may also benefit the childrens general phonological abilities and lead to gains in their literacy skills. AIMS To examine the effectiveness of phonological awareness therapy under conditions more similar to those prevailing in many speech and language therapy clinics. Children were treated in small groups and less intensive therapy was offered than in previous studies. METHODS & PROCEDURES Twenty children were randomly assigned to treated and untreated groups. A pre-/post-test design was used to monitor their progress in phonological awareness, literacy and speech production. Children were treated in groups of three. They received 12 hours of therapy. OUTCOMES & RESULTS Comparisons of the groups showed that the treated group made significantly greater gains in phonological awareness. However, differences between the groups in the measures of literacy and speech production were smaller and non-significant. Considerable variation was detected in the response of individual children to the therapy. CONCLUSIONS The results show the effectiveness of phonological awareness therapy in benefiting childrens general phonological skills. However, the comparison of these and previous findings suggest that children may require more therapy than is often available if literacy and speech production are also to benefit. Further research is required to confirm the duration and intensity of therapy required. Until such information is available, clinicians might want to take a cautious approach and combine therapies that target phonological awareness with more traditional approaches, that target speech production more directly.

Sentence Repetition: What Does the Task Measure?.

BACKGROUND Sentence repetition is gaining increasing attention as a source of information about childrens sentence-level abilities in clinical assessment, and as a clinical marker of specific language impairment. However, it is widely debated what the task is testing and therefore how informative it is. AIMS (1) To evaluate the effects of different types of long-term linguistic knowledge on immediate recall, (2) to assess age sensitivity of repetition tasks designed to evaluate these effects, and (3) to establish if the effects are similar across typologically different languages. The study also considers the implications of the findings for the use of sentence repetition as a research and clinical assessment tool. METHODS & PROCEDURES Participants were 50 English-speaking and 50 Czech-speaking typically developing 4-5-year-olds. Childrens ability to recall sequences of items was compared in seven linguistic conditions ranging from fully well-formed sentences to sequences of non-words. In each condition, children repeated blocks of successively longer stimuli to establish their span. OUTCOMES & RESULTS Results showed significant but differential effects of all linguistic factors in both languages. While syntactic violations and presence of non-words dramatically reduced childrens span, semantic implausibility and the removal of sentence prosody played a significant but much smaller role. Familiarity of function words was more important than familiarity of content words. The effects of different linguistic factors on spans were the same for both languages and did not change between 4 and 5 years, although average spans increased over this age range. CONCLUSIONS & IMPLICATIONS Childrens ability to repeat sentences is more dependent on their familiarity with morphosyntax and lexical phonology than semantics or prosody, with function words of particular importance. Findings have implications for the use of recall in clinical assessment and as a research tool.

Developmental pathways of language and social communication problems in 9-11 year olds: Unpicking the heterogeneity

This paper addressed relations between language, social communication and behaviour, and their trajectories, in a sample of 9-11-year-olds (n=91) who had been referred to clinical services with concerns about language as pre-schoolers. Children were first assessed at 2½-4 years, and again 18 months later. Results revealed increasing differentiation of profiles across time. By 9-11 years, 11% of the sample had social communication deficits, 27% language impairment, 20% both, and 42% neither. The size of group differences on key language and social communication measures was striking (2-3 standard deviations). Social communication deficits included autistic mannerisms and were associated with social, emotional and behavioural difficulties (SEBDs); in contrast, language impairment was associated with hyperactivity only. Children with both language and social communication problems had the most severe difficulties on all measures. These distinct school-age profiles emerged gradually. Investigation of developmental trajectories revealed that the three impaired groups did not differ significantly on language or SEBD measures when the children were first seen. Only low performance on the Early Sociocognitive Battery, a new measure of social responsiveness, joint attention and symbolic understanding, differentiated the children with and without social communication problems at 9-11 years. These findings suggest that some children who first present with language delay or difficulties have undetected Autism Spectrum Disorders which may or may not be accompanied by language impairment in the longer term. This new evidence of developmental trajectories starting in the preschool years throws further light on the nature of social communication and language problems in school-age children, relations between language impairment and SEBDs, and on the nature of early language development.

Body movement imitation and early language as predictors of later social communication and language outcomes: A longitudinal study

Background and aims Over recent decades much research has focused on detecting predictors of different language trajectories in children with early language delay but there has been very little exploration of social communication trajectories in these children. We report a longitudinal study that investigated the predictive value and clinical significance of elicited body movement imitation and language for later social communication and language outcome in Late Talkers. Methods Participants were 29 German-speaking children who were identified with delayed onset and progression of language at two years and followed up at four years. Novel assessments of posture and gesture imitation were administered at Time 1, together with standardised language measures. All body movement imitation items involved self-other mappings, assumed to rely on sociocognitive capacities. At Time 2, children were assessed on standard language tests, together with parental reports of social communication. Results Early language skills at Time 1 were significantly associated with later language outcome and body movement imitation skills at Time 1 with later social communication outcome. Logistic regression analyses revealed that body movement imitation as well as language at Time 1 added significantly to the prediction of language outcome at Time 2, whereas only body movement imitation made a significant contribution to the prediction of social communication outcome at Time 2. Conclusions and implications Theoretically, results highlight the need to account for the heterogeneity of different language and communication trajectories in children with early language delay and point to the importance of sociocognitive difficulties observed in some of these children. Clinically, this study demonstrated that body movement imitation measures have the potential to improve the identification of pre-schoolers who are at risk of later social communication and language problems.

Evaluation of the clinical decisions made for 2‐year‐olds referred for speech and language therapy: a follow‐up study

BACKGROUND Clinicians in the UK rely mainly on informal observations and structured and semi-structured tasks rather than standardized testing in their assessments of pre-school children referred with speech and language difficulties. The informal nature of the clinical decision-making process at this age is unsurprising given the dearth of research on early clinical referrals. Evidence of outcome for young children referred with speech and language problems typically begins in the early school years. AIMS To examine the clinical decision-making of an experienced individual therapist by evaluating the extent to which follow-up evidence supported initial prognosis. METHODS & PROCEDURES Forty-three randomly selected pre-school children referred to speech and language therapy services were seen at an average age of 2;8, when a range of informal assessments were carried out. They were followed up 18 months later. Outcomes were compared with initial diagnosis and prognosis. OUTCOMES & RESULTS Initial judgements showed high associations between the type of problem, the presence of complex difficulties, severity ratings and prognosis. In line with previous findings, prognosis was significantly associated with the type of problem and severity at outcome, although overall changes were more pronounced than had been predicted. A minority of children were rated substantially worse than predicted at follow-up. CONCLUSIONS This study illustrates the potential of this kind of approach to inform the process of decision-making and reflective clinical practice with very young children. Limitations of the study and implications for future action research are discussed.

Nonverbal imitation skills in children with specific language delay.

Research in children with language problems has focussed on verbal deficits, and we have less understanding of childrens deficits with nonverbal sociocognitive skills which have been proposed to be important for language acquisition. This study was designed to investigate elicited nonverbal imitation in children with specific language delay (SLD). It is argued that difficulties in nonverbal imitation, which do not involve the processing of structural aspects of language, may be indicative of sociocognitive deficits. Participants were German-speaking typically developing children (n=60) and children with SLD (n=45) aged 2-3 ½ years. A novel battery of tasks measured their ability to imitate a range of nonverbal target acts that to a greater or lesser extent involve sociocognitive skills (body movements, instrumental acts on objects, pretend acts). Significant group differences were found for all body movement and pretend act tasks, but not for the instrumental act tasks. The poorer imitative performance of the SLD sample was not explained by motor or nonverbal cognitive skills. Thus, it appeared that the nature of the task affected childrens imitation performance. It is argued that the ability to establish a sense of connectedness with the demonstrator was at the core of childrens imitation difficulty in the SLD sample.