Health‐related quality of life of children with low language from early childhood to adolescence: results from an Australian longitudinal population‐based study

Le H.N., Le L.K., Nguyen P.K., Mudiyanselage S.B., Eadie P., Mensah F., Sciberras E., Gold L.

Low language (LL) is a common childhood condition affecting 7-17% of children. It is associated with life-long adverse outcomes and can affect various aspects of a child's life. However, the literature on its impact on health-related quality of life (HRQoL), service use and costs are limited. To date, there has been no systematic review of the overall economic burden of LL. A systematic review regarding the economic burden of LL is important for clinical, educational, policy decision-making and theoretical aspects. We adopted the term 'low language' to refer to children whose language performance falls below well-recognized cut-points regardless of known or unknown aetiology.To review the literature systematically on how LL is associated with HRQoL, service utilization and costs.A systematic search was conducted across various databases, including MEDLINE, Embase, PsycINFO, CINAHL, up to July 2017. Data on study design, population and outcomes were extracted and screened by two pairs of reviewers with the revision of other experts in the panel on any discrepancies. The Effective Public Health Practice Project tool was used to assess the risk of bias of the included studies. The findings of the included studies were summarized in a narrative synthesis.We identified 22 relevant articles, of which 12 reported HRQoL and 11 reported service utilization and costs associated with LL. Preference-based instruments, which include the relative importance attached to different aspects of HRQoL, were less employed in the literature. Most studies found poorer HRQoL in children with LL compared with their peers. About half the families having children with LL did not actively seek professional help, and many families felt they did not receive sufficient services when needed. Healthcare costs associated with LL were substantial. Non-healthcare costs were largely unexplored.LL was associated with reduced children's HRQoL, higher service use and costs. Under-servicing was evident in children with LL. LL also imposed large costs on the healthcare system. Further research is required to examine (1) the overall HRQoL of children with LL, in particular studies using and testing the performance of preference-based instruments; and (2) the service use and costs specific to LL, especially non-healthcare costs.

Eadie P., Conway L., Hallenstein B., Mensah F., McKean C., Reilly S.

Developmental language disorder (DLD) is common in children, but little is known about its association with quality of life (QoL) in middle childhood. QoL is a complex construct, aligning with an individual's sense of well-being and is related to functional limitations associated with DLD. Biopsychosocial models of disability account for both the extent and functional limitations of the impairment; however, the DLD literature rarely reports on both aspects. Studies are required that detail QoL in children with and without DLD.To investigate the association between DLD, identified at 4 years and persisting at 7 years, and QoL over 4, 7 and 9 years; to compare QoL for children whose DLD was mild to moderate and severe at 7 years; and to investigate how variables known to impact on language development (e.g., maternal vocabulary), as well as social-emotional behaviours at 4 and 7 years contribute to QoL at 9 years.The analyses included 872 children who participated in the 4-, 7- and 9-year data collection of the Early Language in Victoria Study (ELVS). We compared the parent-reported QoL profiles at 4, 7 and 9 years for children with and without DLD, and those with mild to moderate and severe DLD using the Pediatric Quality of Life Inventory (PedsQL). We conducted regression analyses to estimate how child, family and environmental factors predicted QoL at 9 years, including social-emotional behaviours measured using the Strengths & Difficulties Questionnaire (SDQ) at 4 and 7 years.Children with DLD (n = 70) had lower parent-reported QoL at 9 years than typically developing children (n = 802), with mean scores of 74.9 and 83.9 respectively. There was no evidence of differences in QoL between those with severe (n = 14) or mild to moderate (n = 56) DLD. In contrast to their peers, children with DLD had a profile of declining QoL between 4 and 9 years. For all children, language skills at 7 years predicted QoL at 9 years. For children with DLD, emotional symptoms and peer problems at 4 years plus SDQ Total Difficulties at 7 years were predictive of lower QoL at 9 years.Children with DLD had a lower QoL than their typical peers at 9 years and, contrary to previous studies, differences in QoL were not observed with DLD severity. Co-occurring social-emotional problems appear to play an important role in contributing to the lower QoL experienced by children with DLD. Consideration of associated functional limitations is required to support the communication and social development of all young children with DLD.

Lyons R., Roulstone S.

Purpose Children with speech and language disorders are at risk in relation to psychological and social well-being. The aim of this study was to understand the experiences of these children from their own perspectives focusing on risks to their well-being and protective indicators that may promote resilience. Method Eleven 9- to 12-year-old children (4 boys and 7 girls) were recruited using purposeful sampling. One participant presented with a speech sound disorder, 1 presented with both a speech and language disorder, and 9 with language disorders. All were receiving additional educational supports. Narrative inquiry, a qualitative design, was employed. Data were generated in home and school settings using multiple semi-structured interviews with each child over a 6-month period. A total of 59 interviews were conducted. The data were analyzed to identify themes in relation to potential risk factors to well-being and protective strategies. Results Potential risk factors in relation to well-being were communication impairment and disability, difficulties with relationships, and concern about academic achievement. Potential protective strategies were hope, agency, and positive relationships. Conclusion This study highlights the importance of listening to children's narratives so that those at risk in relation to well-being can be identified. Conceptualization of well-being and resilience within an ecological framework may enable identification of protective strategies at both individual and environmental levels that can be strengthened to mitigate negative experiences.

Nicola K., Watter P.

Children with specific language impairment often present with multiple comorbidities, which may adversely affect both participation in play and academic performance, potentially impacting a child’s health-related quality of life. This study 1) explored the suitability of the Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales (PedsQL™) for use with a typically developing Australian control group, and 2) compared the health-related quality of life between a control group and Australian children with severe specific language impairment. Health-related quality of life data collected as part of a broader study of 43 children with severe specific language impairment (males = 35, age range 5–16, mean age = 8.79+/− 2.92) enrolled at a special school were used to explore previously unreported findings. Typically developing gender and age matched (+/− 3 months) peers were recruited from local schools. The PedsQL™ child self-report and proxy-report were individually or interviewer-administered to the control group as required, and then compared to the group with specific language impairment. The PedsQL™ was reliable and feasible for use with the control group (N = 43, males = 35, age range = 5–16 years, mean age = 8.74+/− 2.94 years). Control group performance was as expected as per the manual. Parents of the control group scored their children significantly higher than did the children themselves on all scales except the emotional functioning scale. Both the control group children and their parents scored themselves significantly higher on all scales, compared to children with severe specific language impairment and their parents. The PedsQL™ was suitable for use with the control group. Further, the recruitment of a control group provided additional clarity on the extent a severe specific language impairment impacts on an Australian child’s perceived health-related quality of life, compared to the manual cut-off scores. Severe specific language impairment significantly impacts negatively on the health-related quality of life of Australian children across all domains, particularly when compared to an age and gender-matched group of peers. These results warrant the inclusion of health-related quality of life evaluations in the assessment of these children along with a multidisciplinary approach.

McKean C., Wraith D., Eadie P., Cook F., Mensah F., Reilly S.

Little is known about the nature, range and prevalence of different subgroups in language trajectories extant in a population from 4 to 11 years. This hinders strategic targeting and design of interventions, particularly targeting those whose difficulties will likely persist.Children's language abilities from 4 to 11 years were investigated in a specialist language longitudinal community cohort (N = 1,910). Longitudinal trajectory latent class modelling was used to characterise trajectories and identify subgroups. Multinomial logistic regression was used to identify predictors associated with the language trajectories children followed.Three language trajectory groups were identified: 'stable' (94% of participants), 'low-decreasing' (4%) and 'low-improving' (2%). A range of child and family factors were identified that were associated with following either the low-improving or low-increasing language trajectory; many of them shared. The low-improving group was associated with mostly environmental risks: non-English-speaking background, social disadvantage and few children's books in the home. The low-decreasing group was associated with mainly biological risks: low birth weight, socioemotional problems, lower family literacy and learning disability.By 4 years, services can be confident that most children with low language will remain low to 11 years. Using rigid cut-points in language ability to target interventions is not recommended due to continued individual variability in language development. Service delivery models should incorporate monitoring over time, targeting according to language abilities and associated risks and delivery of a continuum of interventions across the continuum of need.

Reilly S., Cook F., Bavin E.L., Bretherton L., Cahir P., Eadie P., Gold L., Mensah F., Papadopoullos S., Wake M.

McKean C., Reilly S., Bavin E.L., Bretherton L., Cini E., Conway L., Cook F., Eadie P., Prior M., Wake M., Mensah F.

OBJECTIVE: To examine at 7 years the language abilities of children, the salience of early life factors and language scores as predictors of language outcome, and co-occurring difficulties METHODS: A longitudinal cohort study of 1910 infants recruited at age 8 to 10 months. Exposures included early life factors (sex, prematurity, birth weight/order, twin birth, socioeconomic status, non–English speaking background,family history of speech/language difficulties); maternal factors (mental health, vocabulary, education, and age); and child language ability at 2 and 4 years. Outcomes were 7-year standardized receptive or expressive language scores (low language: ≥1.25 SD below the mean), and co-occurring difficulties (autism, literacy, social, emotional, and behavioral adjustment, and health-related quality of life). RESULTS: Almost 19% of children (22/1204;18.9%) met criteria for low language at 7 years. Early life factors explained 9-13% of variation in language scores, increasing to 39-58% when child language scores at ages 2 and 4 were included. Early life factors moderately discriminated between children with and without low language (area under the curve: 0.68–0.72), strengthening to good discrimination with language scores at ages 2 and 4 (area under the curve: 0.85–0.94). Low language at age 7 was associated with concurrent difficulties in literacy, social-emotional and behavioral difficulties, and limitations in school and psychosocial functioning. CONCLUSIONS: Child language ability at 4 years more accurately predicted low language at 7 than a range of early child, family, and environmental factors. Low language at 7 years was associated with a higher prevalence of co-occurring difficulties.

Bishop D.V., Snowling M.J., Thompson P.A., Greenhalgh T.

Delayed or impaired language development is a common developmental concern, yet there is little agreement about the criteria used to identify and classify language impairments in children. Children's language difficulties are at the interface between education, medicine and the allied professions, who may all adopt different approaches to conceptualising them. Our goal in this study was to use an online Delphi technique to see whether it was possible to achieve consensus among professionals on appropriate criteria for identifying children who might benefit from specialist services. We recruited a panel of 59 experts representing ten disciplines (including education, psychology, speech-language therapy/pathology, paediatrics and child psychiatry) from English-speaking countries (Australia, Canada, Ireland, New Zealand, United Kingdom and USA). The starting point for round 1 was a set of 46 statements based on articles and commentaries in a special issue of a journal focusing on this topic. Panel members rated each statement for both relevance and validity on a seven-point scale, and added free text comments. These responses were synthesised by the first two authors, who then removed, combined or modified items with a view to improving consensus. The resulting set of statements was returned to the panel for a second evaluation (round 2). Consensus (percentage reporting 'agree' or 'strongly agree') was at least 80 percent for 24 of 27 round 2 statements, though many respondents qualified their response with written comments. These were again synthesised by the first two authors. The resulting consensus statement is reported here, with additional summary of relevant evidence, and a concluding commentary on residual disagreements and gaps in the evidence base.

Norbury C.F., Gooch D., Wray C., Baird G., Charman T., Simonoff E., Vamvakas G., Pickles A.

Diagnosis of 'specific' language impairment traditionally required nonverbal IQ to be within normal limits, often resulting in restricted access to clinical services for children with lower NVIQ. Changes to DSM-5 criteria for language disorder removed this NVIQ requirement. This study sought to delineate the impact of varying NVIQ criteria on prevalence, clinical presentation and functional impact of language disorder in the first UK population study of language impairment at school entry.A population-based survey design with sample weighting procedures was used to estimate population prevalence. We surveyed state-maintained reception classrooms (n = 161 or 61% of eligible schools) in Surrey, England. From a total population of 12,398 children (ages 4-5 years), 7,267 (59%) were screened. A stratified subsample (n = 529) received comprehensive assessment of language, NVIQ, social, emotional and behavioural problems, and academic attainment.The total population prevalence estimate of language disorder was 9.92% (95% CI 7.38, 13.20). The prevalence of language disorder of unknown origin was estimated to be 7.58% (95% CI 5.33, 10.66), while the prevalence of language impairment associated with intellectual disability and/or existing medical diagnosis was 2.34% (95% CI 1.40, 3.91). Children with language disorder displayed elevated symptoms of social, emotional and behavioural problems relative to peers, F(1, 466) = 7.88, p = .05, and 88% did not make expected academic progress. There were no differences between those with average and low-average NVIQ scores in severity of language deficit, social, emotional and behavioural problems, or educational attainment. In contrast, children with language impairments associated with known medical diagnosis and/or intellectual disability displayed more severe deficits on multiple measures.At school entry, approximately two children in every class of 30 pupils will experience language disorder severe enough to hinder academic progress. Access to specialist clinical services should not depend on NVIQ.

Feeney R., Desha L., Khan A., Ziviani J.

Nicola K., Watter P.

This study aimed to evaluate the feasibility and reliability of the Pediatric Quality of Life Inventory™ 4.0 Generic Core Scales (PedsQL™) for use by children with severe specific language impairment (SLI) and their parent, and to explore the health-related quality of life of children with severe SLI. We hypothesized that the PedsQL™ would be a suitable measure, and identify lower health-related quality of life compared to the healthy population sample, particularly in school and social functioning. Forty-three out of 61 children with severe SLI enrolled at a dedicated school from February 2010 until September 2011 agreed to participate. Children and parents completed the PedsQL™ separately with support as required. The PedsQL™ proved to be suitable for this cohort. Children perceived themselves to be at risk of impaired social and physical functioning, rendering the total score below the population mean. Parents rated social and emotional functioning at risk of impairment, with the psychosocial and total summary score consequently below the population mean. Physical functioning had the largest child/parent difference, with children rating themselves below the cut-off score, and parents rating their children above the cut-off score. This measure can be used with this group. Our group of children with severe SLI reported lower health-related quality of life than the healthy population mean as perceived by both the child and the parent. Health professionals working with children who have SLI need to consider not only a child’s impairment, but also their wellbeing and participation by incorporating self- and proxy-reports into assessment in order to promote meaningful therapeutic outcomes that impact positively on a child’s life.

Vella S.A., Magee C.A., Cliff D.P.

To identify distinct trajectories of health-related quality of life (HRQOL) during childhood, along with their predictors.A nationally representative sample of 2700 children aged 4-5 years at baseline was followed up every 24 months through to age 12-13 years. Parents reported the children's HRQOL and data on potential predictors at each wave (5 in total) as part of the Longitudinal Study of Australian Children.Growth mixture modeling identified 5 distinct trajectories of HRQOL during childhood. Eighty-five percent of children had consistently high levels of HRQOL from age 4-5 years to 12-13 years (healthy); 8% of children had a significant and continuous decrease in HRQOL over time (high risk); and a further 5.3% of children had decreases in HRQOL from age 4-5 years to 8-9 years, followed by increases through to 12-13 years (rebound). Finally, a small percentage (1.6%) of children had extremely low levels of HRQOL at age 4-5 years that increased over time (recovery). Maternal smoking, lower household income, living in a non-English speaking household, and nonparticipation in organized sports were predictive of poorer HRQOL trajectories when compared with children in the healthy trajectory.There are distinct trajectories of HRQOL during childhood. Most children (85%) have a healthy, stable pattern, but the remaining children have trajectories indicative of poor HRQOL. Participation in sports, maternal smoking, lower family income, and language spoken at home distinguish among these trajectories. Of these, participation in organized sports has received relatively little attention as a preventative health priority.

Reilly S., Tomblin B., Law J., McKean C., Mensah F.K., Morgan A., Goldfeld S., Nicholson J.M., Wake M.

Background The term ‘specific language impairment’ (SLI), in use since the 1980s, describes children with language impairment whose cognitive skills are within normal limits where there is no identifiable reason for the language impairment. SLI is determined by applying exclusionary criteria, so that it is defined by what it is not rather than by what it is. The recent decision to not include SLI in DSM-5 provoked much debate and concern from researchers and clinicians. Aims To explore how the term ‘specific language impairment’ emerged, to consider how disorders, including SLI, are generally defined and to explore how societal changes might impact on use the term. Methods & Procedures We reviewed the literature to explore the origins of the term ‘specific language impairment’ and present published evidence, as well as new analyses of population data, to explore the validity of continuing to use the term. Outcomes & Results and Conclusions & Implications We support the decision to exclude the term ‘specific language impairment’ from DSM-5 and conclude that the term has been a convenient label for researchers, but that the current classification is unacceptably arbitrary. Furthermore, we argue there is no empirical evidence to support the continued use of the term SLI and limited evidence that it has provided any real benefits for children and their families. In fact, the term may be disadvantageous to some due to the use of exclusionary criteria to determine eligibility for and access to speech pathology services. We propose the following recommendations. First, that the word ‘specific’ be removed and the label ‘language impairment’ be used. Second, that the exclusionary criteria be relaxed and in their place inclusionary criteria be adopted that take into account the fluid nature of language development particularly in the preschool period. Building on the goodwill and collaborations between the clinical and research communities we propose the establishment of an international consensus panel to develop an agreed definition and set of criteria for language impairment. Given the rich data now available in population studies it is possible to test the validity of these definitions and criteria. Consultation with service users and policy-makers should be incorporated into the decision-making process.

Flapper B.C., Schoemaker M.M.

Co-morbidity of Developmental Coordination Disorder (DCD) in children with specific language impairment (SLI) and the impact of DCD on quality-of-life (QOL) was investigated in 65 5-8 year old children with SLI (43 boys, age 6.8±0.8; 22 girls, age 6.6±0.8). The prevalence of DCD was assessed using DSM-IV-TR criteria (American Psychiatric Association (APA), 2000) operationally defined in the clinical practice guideline (CPG): movement ABC scores below 15th percentile, scores on DCDQ and/or MOQ-T below 15th percentile, absence of medical condition according to paediatric-neurological exam. Quality of life (QOL) was measured with the TNO-AZL-Child-Quality-Of-Life (TACQOL) Questionnaire filled out by parents for the SLI group with and without DCD, and compared to a reference group (N=572; age 6.9±0.9). The TACQOL covers 7 QOL domains: physical, motor, cognitive and social functioning, autonomy, positive and negative moods. Prevalence of DCD in children with SLI was 32.3%. In children with SLI, mean QOL scores were significantly lower in the autonomy, cognitive, social and positive moods domains compared to the reference group. Children with SLI and DCD differed from children with SLI without DCD by significantly lower mean overall-, motor-, autonomy-, and cognitive domain-QOL scores. Clinicians should be aware that about one third of children with SLI can also be diagnosed with DCD. Assessment of QOL is warranted in order to assess which domains are affected in children with SLI with or without DCD.

Fellinghauer B., Reinhardt J.D., Stucki G., Bickenbach J.

Disability can be broken down into difficulties in different components of functioning such as impairments and limitations in activities and participation (A&P). Previous studies have produced the seemingly surprising result that persons with severe impairments tend to report high quality of life (QoL) including perceived health regardless of their condition; the so-called “disability paradox”. We aim to study the role of contextual factors (i.e. the personal and environmental situation) in explaining the disability paradox. The Swiss Health Survey provides information on the perceived health of 18,760 participants from the general population. We construct a conditional independence graph applying random forests and stability selection in order to represent the structure of impairment, A&P limitation, contextual factors, and perceived health. We find that impairment and A&P limitations are not directly related but only via a cluster of contextual factors. Similarly, impairment and perceived health are not directly related. On the other hand, perceived health is directly connected with A&P limitations. We hypothesize that contextual factors have a moderating and/or mediating effect on the relationship of impairment, A&P limitations, and perceived health. The disability paradox seems to dissolve when contextual factors are put into consideration. Contextual factors may be responsible for some persons with impairments developing A&P limitations and others not. In turn, persons with impairments may only then perceive bad health when they experience A&P limitation. Political interventions at the level of the environment may reduce the number of persons who perceive bad health.

McKean C., Jack C., Pert S., Letts C., Stringer H., Masidlover M., Trebacz A., Rush R., Armstrong E., Conn K., Sandham J., Ashton E., Rose N.

ABSTRACTBackgroundChildren's language abilities set the stage for their education, psychosocial development and life chances across the life course.AimsTo compare the efficacy of two preschool language interventions delivered with low dosages in early years settings (EYS): Building Early Sentences Therapy (BEST) and an Adapted Derbyshire Language Scheme (A‐DLS). The former is informed by usage‐based linguistic theory, the latter by typical language developmental patterns.MethodsWe conducted a pre‐registered cluster randomized controlled trial in 20 EYS randomized to receive BEST or A‐DLS. Children aged 3;05–4;05, who were monolingual, with comprehension and/or production scores ≤ 16th centile (New Reynell Developmental Language Scales—NRDLS) and no sensorineural hearing impairment, severe visual impairment or learning disability were eligible. A total of 102 children received the intervention. Speech and language therapists delivered interventions with high fidelity in 15‐min group sessions twice weekly for 8 weeks. Baseline (T1), outcome (T2), and follow‐up (T3) measures were completed blind to the intervention arm. Outcomes were NRDLS comprehension and production standard scores (SS), measures of language structures targeted in the interventions and communicative participation (FOCUS‐34).ResultsBoth interventions were associated with significant change from T1 to T2 and from T1 to T3 in all outcomes. There were no differences between interventions in gains in NRDLS comprehension SS at T2 or T3. BEST produced greater gains in NRDLS production SS between T1–T2 (d = 0.40) and T1–T3 (d = 0.55) and in BEST‐targeted sentences (d = 0.77). Children receiving BEST made significantly more progress after intervention (T2–T3) in both comprehension and production. Both interventions were associated with large, clinically significant changes in communicative participation as measured by teacher reports (FOCUS‐34).ConclusionsA low‐dosage intervention can produce language gains with moderate to large effects. The accelerated progress after the BEST intervention underscores the significant potential of interventions designed with reference to usage‐based theory, which precisely manipulates language exposure to promote the specific cognitive mechanisms hypothesized to promote language learning.WHAT THIS PAPER ADDSWhat is already known on the subject Early language development sets the stage for children's educational and psychosocial development and their life chances into adulthood. Early language interventions can be effective; however, there is a need to develop and evaluate early interventions which bring large effects and which can be delivered within the constrained resources of early years provision. Usage‐based linguistics have not been explicitly applied to the design of early language interventions. There is evidence that the Derbyshire Language Scheme (DLS) promotes positive outcomes in comprehension abilities and BEST in production.What this paper adds to the existing knowledge Findings from a cluster‐randomized controlled trial demonstrate that BEST, an 8‐week, 15‐min, small‐group intervention, delivered twice weekly can produce moderate to high effects in expressive language outcomes for 3–4‐year‐old children with low language. A‐DLS and BEST bring similar gains in comprehension standard scores but BEST leads to larger and more sustained progress in expression. Faster progress after intervention for BEST supports the hypothesis that it promotes the development of abstract representations of predicate‐argument structures, supporting generalization and accelerating language learning.What are the potential or actual clinical implications of this work? BEST, a low‐dosage, manualized intervention delivered with high fidelity can be effective for children from a range of socio‐economic backgrounds bringing moderate to high effects. Effective and efficient intervention can be delivered through the precise manipulation of active ingredients within intervention sessions (in this case, the cognitive mechanisms hypothesized to promote language learning and abstract knowledge in usage‐based theory).

Duinmeijer I., Peet S., Janssen L., Scheper A., Zwitserlood‐Nijenhuis M., Bliekendaal W., Zoons M., Hakvoort B.

ABSTRACTBackgroundChildren with developmental language disorder (DLD) have problems acquiring language, affecting their communicative participation, social–emotional functioning (SEF) and quality of life (QoL).AimsTo investigate whether communicative participation mediates the relation between language and SEF and QoL.Methods & ProceduresIn a longitudinal design, 511 children were recruited via early intervention groups for children with (presumed) DLD. Language and IQ scores were obtained at a mean age of 3;11 (T0). In kindergarten, communicative participation, SEF and QoL were measured via parental questionnaires (T1, mean age 4;8). The relationship between language and SEF and QoL was investigated directly and with communicative participation as a mediating factor using structural equation modelling.Outcomes & ResultsExpressive grammar was related to communicative participation, SEF and QoL, while receptive language and expressive vocabulary were not. Children with better expressive grammar at T0 showed better communicative participation at T1. Better communicative participation, in turn, was related to less problems in SEF and higher QoL. We also found an unexpected positive direct relation between expressive grammar and problems in SEF. Post‐hoc analyses showed that this was likely to be a suppressor effect, caused by a small subset of children with relatively good expressive grammar and poor communicative participation.Conclusions & ImplicationsCommunicative participation is a mediator in the relation between language and SEF and QoL. These results underline the importance of addressing communicative participation as a functional measure of language ability both in research and clinical practice.WHAT THIS PAPER ADDSWhat is already known on the subject Children with DLD have problems acquiring language and communication skills. Alongside and related to these challenges, many children with DLD experience greater problems in SEF and lower levels of QoL, although there is considerable variation among children. Previous research has demonstrated that structural language abilities only explain a small part of the variance in well‐being, and more functional language measures, such as pragmatic skills, play an important role.What this paper adds to the existing knowledge This study investigated whether the relation between language problems and well‐being is mediated by children's ability to participate in communication (communicative participation). Structural equation modelling in a large, longitudinal sample of children with (presumed) DLD showed that communicative participation mediates the relationship between language abilities and both SEF and QoL. Better expressive grammatical skills were associated with better communicative participation, which in turn was related to higher SEF and QoL scores. Thus, the relation between language and well‐being is mediated by how effectively children can communicate in daily life.What are the potential or actual clinical implications of this work? For clinicians, this study underlines the importance of addressing communicative participation as a functional measure of language ability. Measuring communicative participation can aid in identifying a child's specific needs and determining the most suitable setting for providing support. Measuring communicative participation can also assist clinicians in setting treatment goals, evaluating intervention effects, and providing advice to parents and schools. Furthermore, this study underscores the importance of recognizing that early language difficulties can affect well‐being.

van Barreveld M., Scheper A., Vissers C., Duinmeijer I., Hakvoort B.

ABSTRACTBackgroundIt is well‐established that children and adolescents with developmental language disorder (DLD) have social–emotional difficulties. This is reflected in their behaviour, for instance, by (social) withdrawal, hyperactivity or difficulty with peer relations. Children with DLD are also known to have poorer quality of life (QoL). This is likely to be related to social–emotional difficulties, for both concern similar developmental domains but from a different point of view. Findings on the social–emotional abilities, QoL and predictors thereof in children with DLD are inconsistent across studies.AimsThis review investigates how social–emotional functioning (SEF) and QoL develop from childhood into early adulthood in children with DLD. These developments are then compared and predictors are identified.Methods & ProceduresA systematic review of 128 articles, conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines in January 2024, yielded 34 articles for inclusion after qualitative assessment. Clinical populations were labelled differently (e.g., DLD, specific language impairment (SLI), language impairment (LI)) but adhered to inclusion criteria for language disorder (LD). The majority of the articles focused on SEF (n = 30 articles), while the remaining examined QoL (n = 4 articles).Main ContributionThis is the first review to simultaneously investigate SEF and QoL in children with LD. No single developmental pattern was found for SEF: a range of possible developmental trajectories exists. Interestingly, prosocial skills generally appear to improve over time, whereas children also experience increasing problems with peer relations. Few studies employed a longitudinal design regarding QoL, but those that did suggest that children with LD are likely to have poorer and declining QoL, at least between the ages of 4 and 9. The sole study examining SEF and QoL in the same sample found a predictive relationship between early SEF and later QoL. Linguistic abilities were predictive in less than half of the studies on SEF development and had little impact on QoL development. Findings on other predictors were inconsistent.ConclusionsDespite their interrelatedness, SEF and QoL do not necessarily develop similarly in children with LD. Only one study examined SEF and QoL in the same children and found contrasting developmental trends. This could imply that SEF and QoL are not as intertwined as presumed. It also remains unclear what best predicts change over time in these two dimensions. More research is necessary to further examine the relationship between SEF and QoL, as well as to identify potential predictors.WHAT THIS PAPER ADDSWhat is already known on the subject Children with LD are more likely than their peers without LD to have lower SEF and poorer QoL. However, the development of these domains across childhood and adolescence remains unclear. The relationship between SEF and QoL is equally under‐researched.What this paper adds to the existing knowledge This is the first review on those with LD that takes a longitudinal perspective on both SEF and QoL and looks at their relationship. It highlights that longitudinal research is valuable and necessary, specifically for QoL, where studies are scarce. Only one study examined SEF and QoL in the same group of children and found a predictive relationship between (aspects of) SEF and later QoL.What are the potential or actual clinical implications of this work? This study highlights the relevance of longitudinal research when aiming to comprehend development, particularly in heterogeneous populations such as language disorders (LD). Clinicians are advised to address social–emotional problems alongside language to potentially increase SEF and QoL. Future research should investigate SEF and QoL simultaneously to substantiate the preliminary evidence for this relationship between SEF and QoL. Additionally, future studies consider support and multilingualism as potential predictors of this development in children with LD.

Mohanakumar Sindhu V.P., Brignell A., Moses M., Kallady K., Bellgrove M.A., Johnson B.P.

ABSTRACTLanguage screening tools are frequently used to identify children with potential undiagnosed language difficulties. These difficulties are more prevalent in autistic children and those with attention deficit hyperactivity disorder (ADHD) compared to neurotypical peers. Despite the widespread use of tools like the Clinical Evaluation of Language Fundamentals, Fifth Edition Screening Test (CELF‐5 Screener) and the Vineland Adaptive Behavior Scales, Third Edition (Vineland‐3), their sensitivity and specificity for this population have not been empirically validated. This study aimed to evaluate the screening accuracy of the CELF‐5 Screener and Vineland‐3 in children diagnosed with autism and/or ADHD and compare their performance to the gold standard measure. The sample consisted of 132 participants (nautism = 25; nADHD = 29, and nautism+ADHD = 78; Mage in years = 9.6; % male = 59) from the Monash Autism‐ADHD Genetics and Neurodevelopment Project. The sensitivity, specificity, positive predictive value, and negative predictive value of the CELF‐5 Screener and Vineland‐3 receptive and expressive language subdomain scores were compared against those of the clinician‐administered CELF‐5 receptive and expressive language composite scores. The screening accuracy of each tool was further evaluated through Receiver Operating Characteristic analyses and calculations of Youden's J statistic. The CELF‐5 Screener demonstrated poor sensitivity for receptive language difficulties (35.6%) while demonstrating high specificity (95.3%). Similarly, for expressive language difficulties, the sensitivity was low (37.9%), and the specificity was high (91.1%). The Vineland‐3 showed high sensitivity (93.3%) but low specificity (48%) for expressive language difficulties and inadequate sensitivity (80.9%) and specificity (22.4%) for receptive language difficulties. Both the CELF‐5 Screener and Vineland‐3 may miss a significant number of children with co‐occurring language difficulties related to autism and/or ADHD. Examiners must understand these tools' strengths and limitations, especially when assessing neurodivergent children whose language development might not follow a normative trajectory.

Larson C.

Purpose: Developmental language disorder (DLD) is a lifelong condition associated with poorer outcomes than neurotypical peers, yet relatively little is known about long-term quality of life in DLD. This preliminary study adopts a neurodiversity-informed approach by exploring self-reported quality of life in an adolescent and young adult DLD sample, as well as linguistic and risk factors contributing to quality of life. Method: Participants were five individuals with DLD aged 12–20 years ( M = 15.60, SD = 3.05). I administered two self-report quality-of-life scales, a language assessment, an experimental morphosyntax task, and measures of risk factors. Data were analyzed descriptively. Results: Participants generally reported positive views about their quality of life, although accessing accommodations and health services emerged as barriers. Relatively better grammaticality judgment performance appeared to be linked with poorer ratings of happiness and the ability to “be yourself.” Nonverbal ability represented a potential risk factor, although there may be a stronger cumulative role for risk factors. Conclusions: Participants with DLD reported relatively good quality of life. Exploratory findings suggest barriers to quality of life in some contexts, as well as roles for individual differences in language and risk factors. These descriptive findings should be examined in larger scale studies and may represent areas of consideration when clinicians address functional challenges that impact mental health and well-being in individuals with DLD. Supplemental Material: https://doi.org/10.23641/asha.27997529

Cioffredi L., Garner B., Maxwell J.R., Merhar S., Peralta-Carcelen M., Scott L.S., Sisodia M., DeMauro S.B.

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social and emotional development beginning prenatally and planned through early childhood. Many prenatal and early childhood exposures impact both later physical health and development. Moreover, early deficits in physical health, such as growth and vision, are associated with differences in brain development, language and cognitive functioning. For these reasons, the HBCD Study includes measures of early childhood physical health, many of which have clinical relevance, and are applicable for use as both predictors and outcomes. Study measures assess a broad range of physical health domains and include both objective measurement of child growth and health and subjective caregiver report of behaviors and attitudes about constructs known to influence growth and physical development. Lastly, we obtain caregiver report of the child's routine medical care as well as acute and chronic medical issues. We anticipate that these data will contextualize the impact of child physical growth and health on child brain development and function. In this report we present the rationale for each domain and an overview of the physical health measures included in the current HBCD Study protocol.

Rodgers L., Botting N., Harding S., Cartwright M., Amer-El-khedoud M., Herman R.

ObjectivesTo descriptively compare and contrast intervention techniques for preschool children with features of developmental language disorder (outcome: oral vocabulary) and speech sound disorder (outcome: speech comprehensibility) and analyse them in relation to effectiveness and theory.DesignThis is a systematic review with narrative synthesis. The process was supported by an expert steering group consisting of relevant professionals and people with lived experience.Data sourcesOvid Emcare, MEDLINE Complete, CINAHL, APA PsycINFO, ERIC, and Communication Source from January 2012 were searched. Relevant studies were obtained from an initial published review (up to January 2012).Eligibility criteriaInterventions for preschool children (80% aged 2:0–5:11 years) with idiopathic speech or language needs; outcomes relating to either oral vocabulary or speech comprehensibility.Data extraction and synthesisSearches were conducted on 27 January 2023. Two independent researchers screened at abstract and full-text levels. Data regarding intervention content (eg, techniques) and format/delivery (eg, dosage, location) were extracted. Data were synthesised narratively according to the methods of Campbellet al.Results24 studies were included: 18 for oral vocabulary and 6 for speech comprehensibility. There were 11 randomised controlled trials, 2 cohort studies and 11 case series. Similarities included a focus on input-related techniques and similar therapy activities. Speech studies were more likely to be professional-led and clinic-led, rather than at home and through a parent. Analysis was restricted by heterogeneity in study design and terminology, as well as gaps within intervention reporting. Information deemed important to the expert steering group was missing.ConclusionsSimilarities and differences between intervention techniques for oral vocabulary and speech comprehensibility have been identified and synthesised. However, analysis of effectiveness was limited due to issues with study design and heterogeneity within studies. This has implications for the progression of the evidence base within the field.PROSPERO registration numberCRD42022373931.

Elm L., Lundeborg Hammarström I., Samuelsson C., Plejert C.

Larson C.

AbstractPurposeDevelopmental language disorder (DLD) is a lifelong condition associated with poorer outcomes than neurotypical peers, yet relatively little is known about long-term quality of life in DLD. This preliminary study adopts a neurodiversity-informed approach by exploringself-reportedquality of life in an adolescent and young adult DLD sample, as well as linguistic and risk factors contributing to quality of life.MethodParticipants were five individuals with DLD aged 12-20 years (M = 15.60; SD = 3.05). I administered two self-report quality of life scales, a language assessment, an experimental morphosyntax task, and measures of risk factors. Data were analyzed descriptively.ResultsParticipants generally reported positive views about their quality of life, though accessing accommodations and health services emerged as barriers. Relatively better grammaticality judgement performance appeared to be linked with poorer ratings of happiness and the ability to ‘be yourself.’ Nonverbal ability represented a potential risk factor, though there may be a stronger cumulative role for risk factors.ConclusionsDLD participants reported relatively good quality of life. Exploratory findings suggest barriers to quality of life in some contexts, as well as roles for individual differences in language and risk factors. These descriptive findings should be examined in larger scale studies and may represent areas of consideration when clinicians address functional challenges that impact mental health and wellbeing in individuals with DLD.

Wieczorek K., DeGroot M., Madigan S., Pador P., Ganshorn H., Graham S.

Purpose: This systematic review and meta-analysis aimed to examine the association between language skills and social competence in children with developmental language disorder (DLD) and to assess the potential moderators of these associations. Method: The study was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were identified according to a search strategy carried out in PsycINFO, MEDLINE, Scopus, Linguistics and Language Behavior Abstracts, and ProQuest Dissertations and Theses Global databases. A total of 15,069 articles were independently double screened in the title and abstract phases, with 250 articles proceeding to a full-text review. Inclusion criteria comprised (a) a sample of children with DLD between the ages of 2 and 12 years, (b) a language measure, (c) a social competence measure, and (d) an appropriate statistic. Exclusion criteria were (a) intervention studies with no baseline data, (b) language measures based on preverbal abilities, (c) samples of children with DLD and other clinical conditions, and (d) studies without useable statistics. Data were extracted from 21 studies that met the eligibility criteria for the meta-analysis. Results: Pooled estimates across 21 studies ( M age = 7.52 years; 64% male) and 6,830 children indicated a significant association between language skills and social competence in children with DLD ( r = .18, 95% confidence interval [.12, .24], p < .001), which was small in magnitude. The effect sizes were stronger in studies that assessed overall language skills than in those that specifically measured receptive or expressive language skills. Conclusions: Findings from this study support a subtle and reliable relationship between language and social competence in children with DLD. The implications and limitations of this study and its future directions are also discussed. Supplemental Material: https://doi.org/10.23641/asha.24514564

Boukouvala M., Hyphantis T., Koullourou I., Tzotzi A., Mitropoulou A., Mantas C., Petrikis P., Serdari A., Siafaka V., Kotsis K.

Language disorders are associated with difficulties in various aspects of life, such as academic and social functioning, resulting in impaired health-related quality of life (HRQoL). Most studies use a parent proxy method to assess HRQoL. Since HRQoL refers to the subjective experience of an individual, it is necessary to assess children’s perspectives along with their mothers’. The aim of the current study is to explore HRQoL rating agreement between children and their mothers, since the literature on other conditions suggests that discrepancies seem to reflect their different perspectives. Thus, 53 Greek-speaking children diagnosed with DLD attending kindergarten and their mothers completed, respectively, self-report and parent proxy PedsQLTM questionnaires. Mothers reported significantly better HRQoL than their children with developmental language disorder (DLD) in all HRQoL domains (p < 0.001). Poor agreement was revealed after comparing the scores from both responders, both in abstract domains, such as emotional functioning, as well as in more observable ones, such as physical health (ICC ranged from −0.05 to 0.07). Bland–Altman plots also showed poor agreement on HRQoL. Our results expand on the already known, from other conditions, importance of evaluating children’s subjective experience of their HRQoL in kindergarten children with DLD. A multi-informant approach is ideal, and clinicians should prioritize children’s view about their lives even when they are kindergarten-age. This approach could inform interventions focusing not only on language skills but also on other areas where it is necessary, depending on the child’s subjective experience combined with the maternal perspective.

Smith A., Bryson H., Gartland D., Mensah F., Wood C.E., Price A.

Intimate partner violence (IPV) is associated with an increased risk of poorer child development. Existing research has focused on physical abuse with less known about the associations with emotional IPV.To describe the period prevalence of mother's experiences of emotional IPV during children's preschool years and associations with child mental, physical, social, and cognitive development.Secondary analysis of control group data (n = 194) from an Australian randomised trial (right@home), which recruited pregnant women experiencing social adversity from antenatal clinics in 2013-14. Women reported emotional abuse (Composite Abuse Scale) at child ages 3-5 years. Measures of child development at 5 years included: Strengths and Difficulties Questionnaire, Social Skills Improvement System, Pediatric Quality of Life Inventory, Clinical Evaluation of Language Fundamentals, School Entry Alphabetic and Phonological Awareness Readiness Test, NIH executive function subtests, sleep and health. The prevalence of emotional IPV from 3 to 5 years was estimated. Regression models compared developmental outcomes according to emotional IPV exposure, adjusted for child age, child gender, and maternal education. Missing data were accounted for using multiple imputation.From 3-5 years, emotional IPV was experienced by 57% of women. Emotional IPV exposure was consistently associated with poorer child developmental outcomes. Differences were most apparent for SDQ internalising (mean difference 1.2, 95% CI 0.2 to 2.1) and externalising difficulties (1.2, 95% CI -0.1 to 2.4).Emotional IPV was highly prevalent amongst families experiencing social adversity. Developing acceptable and effective identification processes and interventions that prioritise families experiencing co-occurring social adversities should be a public health priority.

Haukedal C.L., Wie O.B., Schauber S.K., von Koss Torkildsen J.

Purpose: The purpose of this study was to examine quality of life (QOL) and its relation to language skills in children with developmental language disorder (DLD). This was examined by comparing QOL to a control group of children with typical development (TD), as well as children with cochlear implants (CIs), who potentially struggle with language for language, although for a different reason than children with DLD. Method: Two groups of children, a group with TD ( n = 29) and a group of children with CIs ( n = 29), were matched to the DLD group ( n = 29) on chronological age, gender, nonverbal IQ, and parental educational level through a propensity matching procedure. A third group consisting of children with CIs was also matched to the DLD group but additionally matched on language abilities. QOL scores were compared across groups, and the association between language skills and QOL was examined in the DLD group. Result: The DLD group was reported by parents to have statistically significantly poorer QOL scores than peers with TD or CIs. When controlling for language skills, either statistically or through an additional CI group matched on language abilities, there were no statistically significant differences in QOL scores across groups. In the DLD group, language skills explained 16% of the variation in QOL. Conclusion: DLD is associated with the children's overall QOL, and the degree of reduced QOL relates to the severity of the language impairment.

O’Loughlin R., Hiscock H., Devlin N., Dalziel K.

Abstract Background To identify and describe distinct developmental trajectories of health-related quality of life (HRQoL) in a national level Australian population sample, overall and separately for boys and girls. Methods Data were from the Longitudinal Study of Australian Children (LSAC). Participants were children aged 4–5 years recruited in 2004 and followed through to age 16–17 years in 2016, and their caregivers. Group-based trajectory modelling was used to identify groups of children that follow qualitatively distinct developmental trajectories of HRQoL. Results Three distinct trajectories were identified for the total sample: (1) high-stable (52.2% of children); (2) middle-stable (38.0%); and (3) low-declining (9.8%). These trajectories differed for boys, who saw increasing HRQoL in the highest trajectory group; a middle-stable trajectory; and declining and rebounding HRQoL in the lowest trajectory group. In contrast, girls saw no increasing or rebounding trajectories; approximately half of girls had high-stable HRQoL and the remaining half had either steadily or rapidly declining HRQoL from age 4–5 to 16–17 years. Conclusions Our results highlight the importance of considering the distinct trajectories for girls and boys and not relying on population mean levels of HRQoL for decision-making. The presence of developmentally distinct trajectories of HRQoL, and differences in the trajectories faced by boys and girls, should be considered when assessing the effectiveness of treatments and interventions impacting upon HRQoL throughout childhood and adolescence. Failure to account for these pre-existing trajectories may over- or under-estimate treatment effects.

Rodgers L., Botting N., Cartwright M., Harding S., Herman R.

IntroductionEvidence suggests that over one-third of young children with developmental language disorder (DLD) or speech sound disorder (SSD) have co-occurring features of both. A co-occurring DLD and SSD profile is associated with negative long-term outcomes relating to communication, literacy and emotional well-being. However, the best treatment approach for young children with this profile is not understood. The aim of the proposed review is to identify intervention techniques for both DLD and SSD, along with their shared characteristics. The findings will then be analysed in the context of relevant theory. This will inform the content for a new or adapted intervention for these children.Methods and analysisThis search will build on a previous systematic review by Roulstoneet al(2015) but with a specific focus on oral vocabulary (DLD outcome) and speech comprehensibility (SSD outcome). These outcomes were identified by parents and speech and language therapists within the prestudy stakeholder engagement work. The following databases will be searched for articles from January 2012 onwards: Ovid Emcare, MEDLINE Complete, CINAHL, APA PsycINFO, Communication Source and ERIC. Two reviewers will independently perform the title/abstract screening and the full-text screening with the exclusion criteria document being revised in an iterative process. Articles written in languages other than English will be excluded. Data will be extracted regarding key participant and intervention criteria, including technique dosage and delivery details. This information will then be pooled into a structured narrative synthesis.Ethics and disseminationEthical approval is not needed for a systematic review protocol. Dissemination of findings will be through peer-reviewed publications, social media, and project steering group networks.PROSPERO registration numberCRD4202237393.