Zoë Simkin

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.

CMIP and ATP2C2 modulate phonological short-term memory in language impairment

Specific language impairment (SLI) is a common developmental disorder characterized by difficulties in language acquisition despite otherwise normal development and in the absence of any obvious explanatory factors. We performed a high-density screen of SLI1, a region of chromosome 16q that shows highly significant and consistent linkage to nonword repetition, a measure of phonological short-term memory that is commonly impaired in SLI. Using two independent language-impaired samples, one family-based (211 families) and another selected from a population cohort on the basis of extreme language measures (490 cases), we detected association to two genes in the SLI1 region: that encoding c-maf-inducing protein (CMIP, minP = 5.5 × 10−7 at rs6564903) and that encoding calcium-transporting ATPase, type2C, member2 (ATP2C2, minP = 2.0 × 10−5 at rs11860694). Regression modeling indicated that each of these loci exerts an independent effect upon nonword repetition ability. Despite the consistent findings in language-impaired samples, investigation in a large unselected cohort (n = 3612) did not detect association. We therefore propose that variants in CMIP and ATP2C2 act to modulate phonological short-term memory primarily in the context of language impairment. As such, this investigation supports the hypothesis that some causes of language impairment are distinct from factors that influence normal language variation. This work therefore implicates CMIP and ATP2C2 in the etiology of SLI and provides molecular evidence for the importance of phonological short-term memory in language acquisition.

Loss of language in early development of autism and specific language impairment

BACKGROUND Several authors have highlighted areas of overlap in symptoms and impairment among children with autism spectrum disorder (ASD) and children with specific language impairment (SLI). By contrast, loss of language and broadly defined regression have been reported as relatively specific to autism. We compare the incidence of language loss and language progression of children with autism and SLI. METHODS We used two complementary studies: the Special Needs and Autism Project (SNAP) and the Manchester Language Study (MLS) involving children with SLI. This yielded a combined sample of 368 children (305 males and 63 females) assessed in late childhood for autism, history of language loss, epilepsy, language abilities and nonverbal IQ. RESULTS language loss occurred in just 1% of children with SLI but in 15% of children classified as having autism or autism spectrum disorder. Loss was more common among children with autism rather than milder ASD and is much less frequently reported when language development is delayed. For children who lost language skills before their first phrases, the phrased speech milestone was postponed but long-term language skills were not significantly lower than children with autism but without loss. For the few who experienced language loss after acquiring phrased speech, subsequent cognitive performance is more uncertain. CONCLUSIONS Language loss is highly specific to ASD. The underlying developmental abnormality may be more prevalent than raw data might suggest, its possible presence being hidden for children whose language development is delayed.

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.

Evidence of reading difficulty in subgroups of children with specific language impairment

The literacy abilities of 11-year old children with specific language impairment (SLI) were investigated through comparing subgroups with current expressive-only language impairment (E-SLI, n 30), current combined expressive and receptive language impairment (ER-SLI, n 32) and a history of now-resolved language impairment (Resolved-SLI, n 28). The ER-SLI subgroup performed less well than the E-SLI subgroup on measures of single word reading and reading comprehension and in turn the E-SLI subgroup performed less well than the Resolved-SLI subgroup. Further analysis of individual variation within subgroups revealed that all three subgroups had a considerable proportion of individuals with literacy difficulties. In addition, direct comparisons of E-SLI versus ER-SLI subgroups revealed the ER-SLI subgroup to have a significantly larger proportion of children with severe literacy difficulties than the E-SLI subgroup. In contrast, the Resolved-SLI subgroup had virtually no children with severe literacy difficulties. The implications of these findings for practice are discussed.

Non-word repetition and grammatical morphology: normative data for children in their final year of primary school

It is likely that tests of phonological short-term memory (non-word repetition) and grammatical morphology (past tense, third-person singular) are clinical markers for specific language impairment (SLI). The study provides normative data on three specific tests covering the aforementioned areas for 100 children attending the final year of primary schooling (10-11 year olds). Data from typically developing age controls can be used to provide a benchmark against which to compare the ability of language-impaired children. This is particularly important given that the transition from primary to secondary schooling is a key stage in a childs education.

Functional Outcomes of Adolescents with a History of Specific Language Impairment (SLI) with and without Autistic Symptomatology

This study investigates whether the level of language ability and presence of autistic symptomatology in adolescents with a history of SLI is associated with differences in the pattern of difficulties across a number of areas of later functioning. Fifty-two adolescents with a history of SLI participated. At age 14, 26 participants had a history of SLI but no autistic symptomatology and 26 had a history of SLI and autistic symptomatology. At age 16, outcomes were assessed in the areas of friendships, independence, academic achievement, emotional health and early work experience for both subgroups and for 85 typically developing peers. Autistic symptomatology was a strong predictor of outcomes in friendships, independence and early work experience whilst language was a strong predictor of academic achievement. No significant associations were found for later emotional health.

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.