Specific Language Impairment (SLI): Outcomes in Adolescence … · 2015-09-07 · 2 1Specific...
Transcript of Specific Language Impairment (SLI): Outcomes in Adolescence … · 2015-09-07 · 2 1Specific...
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Specific Language Impairment (SLI): Outcomes in Adolescence
Gina Conti-Ramsden
The University of Manchester
Kevin Durkin
University of Strathclyde
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1Specific Language Impairment (SLI): Outcomes in Adolescence
Children and young people with specific language impairment (SLI) represent a
group of individuals who have deficits in language ability whilst “everything else”
appears to be normal. That “everything else” includes, by definition, adequate input from
the senses: normal hearing and normal/corrected vision. It also includes an adequate
biological basis to develop language (they have no obvious signs of brain damage) and an
adequate basis for learning, i.e., their nonverbal abilities as measured by IQ are similar to
those of their peers of the same age. A desire to engage socially is also important:
children and young people with SLI seek to interact socially with adults and peers and as
such are not like children with autism who are not as socially engaged. This definition of
SLI which is commonly in use has a number of key implications for our understanding of
the impairment.
First, SLI is conceived as a primary difficulty with language. Indeed all young
children who are likely to later have SLI are in the first instance late talkers in the non-
technical sense. That is, the appearance of their first words is delayed compared to what
is expected of most young children. Word combinations such as “want juice”, “bye-bye
teddy” also appear at a later age than would be expected. This is true for children learning
not just English, but any language. Generally, across languages, children with SLI are
described as having more difficulty with talking (producing words) than with
understanding what is said to them (comprehending language). Although difficulties
with talking attract the most attention and can occur in isolation, many children present
1 The contents of this chapter have been presented in previous publications, in particular, Conti-Ramsden (2008) and Durkin & Conti-Ramsden (2007).
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with difficulties in both talking and understanding. It is much more rare to see children
who have problems understanding what is said to them but can talk normally (except in
the case of some children with autism).
Second, in SLI this primary difficulty with language is assumed to hold the key to
the explanation of why these children have difficulties. In other words, there is an
assumption that the language deficit is a manifestation of something wrong with whatever
the language learning mechanism may be. In the definition of SLI, other possible causes
of a language difficulty are excluded: the child does not have hearing problems so the
hearing is not causing the language difficulty. In the same vein, the child does not have
learning difficulties so these can not be causing the language difficulty. The child
appears to be social and want to communicate, so interpersonal, social difficulties can not
be causing the language difficulty.
Third, in SLI this primary difficulty with language is assumed to be a defining
characteristic that, if unresolved, stays with children as they reach adolescence and young
adulthood. We do not see in textbooks or manuals a change in the definition of SLI from
childhood to adolescence, for example. Textbooks and manuals are likely to acknowledge
that SLI is a developmental condition, that it can be persistent and stay with children as
they grow up, and that it can be heterogeneous. Yet, the current definition of SLI most
commonly used is in a way static and does not explicitly tell us about what to expect as
children with SLI grow up.
In this chapter we will examine precisely this issue: what are the developmental
outcomes for SLI in adolescence and what do these outcomes tell us about the nature of
SLI itself? We will base our observations on our longitudinal investigation of SLI: the
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Manchester Language Study. Furthermore, we will argue that the accumulating findings
on outcomes in adolescence prompt a revision of the assumptions outlined above; that is,
the evidence suggests that SLI is interwoven with other difficulties.
The Manchester Language Study
This investigation began with an original cohort of 242 children who represented
a random 50% of all children attending year 2 (aged 7 years old) in language units across
England. Language units in England are classes, usually one or two attached to
mainstream schools, that offer specialist language environments for children with SLI.
The staff:student ratio in these mixed-aged classes is high, at one staff member for
approximately 10 students. Staff include a specialist teacher and a classroom or speech
therapy assistant as well as regular speech and language therapy input provided by a
qualified therapist (for more information on language units and educational provision for
children with SLI in England see Conti-Ramsden & Botting, 2000). Children reported by
teachers to have frank neurological difficulties (brain damage), diagnoses of autism,
known hearing impairment or general learning impairments were excluded. All children
had English as a first language, but 12% had exposure to languages other than English at
home. In our original sample, 53.1% of the participants came from households earning
less than the average family wage for that year. The cohort has been assessed at 8 years
of age (n=234), 11 years of age (n=200), at 14 years of age (n=130) and 16 years of age
(n = 139). The adolescents who agreed to participate at 16 years, and that form the basis
of the data to be discussed in this study, did not differ on any early variables of language,
behaviour, cognition or social-economic status (SES) compared to those who did not
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participate. The adolescents showed a variety of different language profiles, with the
majority described as having both receptive and expressive difficulties.
At age 16 years, the Manchester Language Study expanded to include a
comparison group of adolescents from a broad background who did not have a history of
special educational needs or speech and language therapy provision. In total, 124 young
people with normal language development (NLD) aged between 15 years 2 months and
16 years 7 months (mean age 15;11 years) agreed to participate. Census data as per 2001-
2002 General Household Survey (UK Office of National Statistics) were consulted in
order to target adolescents who would be representative of the range and distribution of
households in England in terms of household income and maternal education. In post-hoc
analysis, there was also no significant difference between NLD adolescents and
adolescents with SLI in maternal education levels (χ2(2)=1.756, p=.416) or household
income bands (χ2(3)=4.391, p=.222). There were also no significant differences in the
proportions of girls in each group (SLI=42/139; NLD=47/124; Fisher’s exact p=0.20).
Table 1 presents the characteristics of the adolescents with SLI and NLD adolescents in
terms of their age, current language and cognitive functioning. Language and cognitive
functioning are derived from standardized tests with a mean of 100 and a standard
deviation of 15. Thus, a score between 85 and 115 (i.e. within one standard deviation of
the mean) is indicative of normal performance and 68% of scores from typical
adolescents would fall within this range. As can be seen from the results presented in
Table 1, the group of adolescents with SLI had means below 85 on the three measures
presented.
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Outcomes at 16 Years: Literacy, Friendships and Emotional Health
To meet the definition of SLI currently in use, we would expect these adolescents
to have selective impairments in language functioning. Deficits outside the language
system may be a consequence of having impaired language or they may be caused by
other concomitant deficits. What is crucial is to examine other areas of functioning in
SLI and to do so beyond childhood. We have examined a number of areas of functioning
as part of our work including educational achievement (Conti-Ramsden, Durkin, Simkin,
& Knox, 2009; Durkin, Simkin, Knox, & Conti-Ramsden, 2009), independence (Conti-
Ramsden, & Durkin, 2008), shyness (Wadman, Durkin, & Conti-Ramsden, 2008) and use
of new media (Durkin, Conti-Ramsden, Walker, & Simkin, 2009). In this chapter we
focus on three areas of related functioning: literacy, friendships and emotional health.
Literacy outcomes
Recent evidence increasingly suggests that children with SLI are likely to
experience literacy problems (e.g. Catts, 1991; Catts, Fey, Tomblin, & Zhang, 2002;
Conti-Ramsden, Donlan, & Grove, 1992; Snowling, Bishop, & Stothard, 2000) and
children who have reading problems, i.e. dyslexia, are likely to experience difficulties
with oral language skills beyond the area of phonology (Joanisse, Manis, Keating, &
Seidenberg, 2000; McArthur, Hogben, Edwards, Heath, & Mengler, 2000). The literature
suggests there is an overlap of about 50%. As noted by Snowling and Hulme (2008),
literacy builds on a foundation of oral language skills. Decoding skills are closely related
to phonological abilities, whereas reading comprehension is more closely allied to non-
phonological language skills (Bishop & Snowling, 2004). Thus, it is not surprising that
the results of a number of studies suggest an association between reading skills and the
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language profiles of children with SLI. Some investigators have focused on global
measures such as the severity of the language impairment. Children’s level of
performance on standardised tests of language expression (talking) and language
understanding have been found to be closely associated with reading achievement (e.g.,
Bishop & Adams, 1990; Tallal, Dukette, & Curtiss, 1989; Wilson & Risucci, 1988).
Furthermore, Bishop (2001) argues that the risk of developing literacy difficulties
increases with the number of impaired language domains the child experiences, i.e.
language expression and language understanding. In this extensive twin study involving 8
year olds, Bishop found that 29% of children with SLI who were impaired in one
language domain had difficulties with reading. In contrast, a much larger proportion of
children with SLI (72%) who were impaired in two language domains had difficulties
with reading.
Thus, there appears to be substantial evidence to suggest that children with SLI
are likely to experience reading difficulties at school age. In addition, it appears that
children with SLI who have severe impairments or impairments in more than one domain
of language appear to be at higher risk of developing reading difficulties.
We investigated two different types of reading outcome: reading accuracy and
reading comprehension (see also Botting, Simkin, & Conti-Ramsden, 2006). Reading
accuracy refers to the ability to decode what the words are, for example to read them out
loud. Reading comprehension is about understanding what has been read, for example to
answer some questions about a story. Interestingly, reading accuracy and reading
comprehension have been shown to be dissociated in the development of some atypical
populations. This includes those with dyslexia, whose decoding/accuracy skills tend to be
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poorer than comprehension skills (Bishop & Snowling, 2004) and poor comprehenders
who (by definition) show average reading accuracy in the context of poor text
comprehension (Cain & Oakhill, 1996).These different reading outcomes may also show
different rates of impairment in children with SLI. In our study of 16 year olds and in line
with previous research (Snowling et al., 2000), we found that adolescents with SLI had
more difficulties with reading comprehension than with reading accuracy (see Table 2 for
details). We then examined predictors of reading outcome. How much do concurrent
language skills predict reading outcome? How does concurrent language fare as a
predictor in relation to other factors such as nonverbal IQ?
Our results suggest that language expression and language understanding were
associated with reading accuracy and reading comprehension. Language was the
strongest predictor, explaining 30% of the variance, with nonverbal IQ also influencing
these outcomes. Thus, the predictor variables were, in order, language followed by
nonverbal IQ.
There was evidence of variability in literacy outcomes, i.e. heterogeneity within
our sample of adolescents with SLI. In addition to the information illustrated above in
table 2, the box below illustrates the fact that we find, amongst young people with a
history of SLI, a proportion of adolescents that are competent readers.
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●Approximately one quarter of the young people had reading accuracy and
comprehension scores 1SD above the expected mean
In summary, these results show that joint impairment of language understanding
and production in SLI is associated with outcome in literacy skills at 16 years of age, i.e.,
even when IQ is controlled for, concurrent language skills have an important predictive
contribution to reading skills at 16 years. Tests involving structural aspects of
language/syntax, both in the expressive and language understanding domains, are the
most implicated in this association. A number of studies have shown an association
between oral language skills and reading comprehension. Similarly to the present study,
Tallal, Curtiss and Kaplan (1988) and Wilson and Risucci (1988) found that spoken
language comprehension deficits predicted later reading difficulties in children with SLI.
However, although our results are in line with this conclusion, the present study indicates
that expressive language skills also show associations with reading comprehension ability
and thus is consistent with studies of young children with SLI where mean length of
Competent readers (24%)
Both reading accuracy and comprehension difficulties (47%)
Reading accuracy difficulties only (2%)
Reading comprehension difficulties only (27%)
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utterance (MLU) has been found to be a predictor of reading ability (e.g. Bishop &
Adams, 1990). At the same time, it must be noted that regardless of relative language
ability, this population of young people is at very great risk of reading impairment in
adolescence: 76% of our participants showed reading difficulties. Only a relatively small
minority of ‘competent readers’ were found in our group, demonstrating a strong
association between oral language skills and literacy abilities in adolescence. In terms of
competent readers, it was found that 63% had age appropriate concurrent language scores
as measured by the Clinical Evaluation of Language Fundamentals (CELF-R, Semel,
Wiig & Secord, 1987). The remainder had language difficulties that were nearly all
expressive in nature (as measured by the CELF-R Recalling Sentences subtest).
Friendships
Durkin and Conti-Ramsden (2007) describe friendships as being a vital
dimension of child development. They are key markers of the selectivity of interpersonal
relations, providing social and cognitive scaffolding (Hartup, 1996), serving variously as
sources of support and information as well as buffers against many of life’s problems,
with enduring implications for self-esteem and wellbeing (Hartup & Stevens, 1999;
Shulman, 1993). Children and adolescents without friends, or with poor friendship
quality, are at risk of loneliness and stress (Bagwell et al., 2005; Hartup & Stevens, 1999;
Ladd, 1990; Ladd, Kochenderfer, & Coleman, 1996).
Friendship relations are complex and this reflects in part the ways in which they
interweave with other developmental processes, such as developing interpersonal and
communicative skills, increasing social cognitive competence and changing personal
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needs. For example, very young children form friendships largely on the basis of
proximity and shared activities; during middle childhood friendships involve greater
levels of interchange and awareness of individual attributes; and in adolescence many
people seek via friendships to satisfy psychological needs for intimacy, shared outlooks
and identity formulation (Buhrmester, 1990, 1996; Hartup & Stevens, 1999; Parker &
Gottman, 1989; Steinberg & Morris, 2001).
In the case of children with language impairments, it appears that they are at a
disadvantage in peer relations from at least their preschool days. They engage less in
active conversational interactions than typically developing peers, enter less frequently
into positive social interactions, are less sensitive to the initiations offered by others, have
poorer discourse skills, manifest situationally-inappropriate verbal responses, achieve
fewer mutual decisions and are more likely to have their bids to influence others prove
unsuccessful (Brinton, Fujiki, & McKee, 1998; Craig, 1993; Craig & Washington, 1993;
Grove, Conti-Ramsden, & Donlan, 1993; Guralnick, Connor, Hammond, Gottman, &
Kinnish, 1996; Hadley & Rice, 1991; Vallance, Im, & Cohen, 1999). In short, the
communicative basis for close reciprocal relationships is circumscribed by SLI.
Communicative abilities are not the only factors that may impede peer relations in
individuals with SLI. These children tend also to score lower than typically developing
children on a range of measures of social skills, social cognitive abilities and emotional
and behavioral self-regulation (Cohen, Barwick, Horodezky, Vallance, & Im, 1998;
Fujiki, Brinton, & Clarke, 2002; Fujiki, Brinton, & Todd, 1996; Lindsay & Dockrell,
2000; Marton, Abramoff, & Rosenzweig, 2005). Young people with SLI tend to be rated
as more withdrawn than age-matched comparisons (Brinton & Fujiki, 1999; Cohen et al.,
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1998; Fujiki et al., 1996; Fujiki, Brinton, Isaacson, & Summers, 2001; Redmond &
Rice, 1998) yet they are at heightened risk of exhibiting externalizing problems and
antisocial conduct disorders (Beitchman et al., 2001; Conti-Ramsden & Botting, 2004;
Brownlie et al., 2004).
Children with SLI are less likely to exhibit skilled prosocial behavior. Fujiki,
Brinton, Morgan, and Hart (1999) reported that participants (aged 5 to 13 years) with
language impairments were rated significantly below typical peers on teacher ratings of
prosocial behavior. Conti-Ramsden and Botting (2004) found that detailed case studies
presented by Brinton, Fujiki, Montague and Hanton (2000) suggest that language
difficulties, social withdrawal and a lack of prosocial skills are compounded, with the
outcome that children find it difficult to work in collaborative peer groups. Stevens and
Bliss (1995) found that children with SLI were less likely to propose prosocial
(cooperative) solutions to conflicts. Thus, deficits in other fundamental interpersonal
capacities appear to be associated with SLI. Indeed, children with SLI have been found
to have fewer friends and appear to be less satisfied with peer relationships compared to
age-matched classmates (Fujiki et al., 1996). Fujiki et al. (1999) conducted a detailed
examination of peer relations in eight children aged six to 11 years with SLI attending
mainstream schools. Peer sociometric ratings and reciprocal friendship nominations were
collected from the target children and their classmates. Strikingly, five of the eight
children with SLI were not named by any child as a best friend; two of the children with
SLI who named other children as their best friends received the lowest possible ratings on
the sociometric scale. In short, these children appeared not only to have impoverished
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friendship relations but, in some cases, had inaccurate perceptions of the status of their
relationships with others.
Accumulating evidence confirms that social and behavioral difficulties in this
group are not short-term problems. A pattern of social difficulties is characteristic not
only of relatively early peer relations but remains marked through later childhood and
adolescence (Brinton, Fujiki, & Higbee, 1998; Brinton, Fujiki, Spencer, & Robinson,
1997; Conti-Ramsden & Botting, 2004; Fujiki, Brinton, Robinson, & Watson, 1997;
Stevens & Bliss, 1995), and into adulthood (Clegg, Hollis, Mawhood, & Rutter, 2005;
Howlin, Mawhood, & Rutter, 2000). However, in the context of conduct disorders and
other manifest problems, relative impoverishment of friendship development may be less
salient for caregivers and teachers (Conti-Ramsden & Botting, 2004).
Although there are several studies pointing to problems in peer acceptance and
friendship formation among children with SLI, much less is known of the patterns in
adolescence, notwithstanding the widely acknowledged heightened importance of peer
relations at this stage of life. More generally, there is a dearth of longitudinal study of
friendships and the factors that influence them (Hartup, 1996), especially in relation to
children with SLI (Farmer, 2000). In our Durkin and Conti-Ramsden (2007) paper we
aimed to address this gap and examined friendship quality in our sample of adolescents
with SLI and their NLD peers at age 16 years. We asked them a series of questions
regarding friends and acquaintances, for example, how easy do you find to get on with
other people? If you were at a party or social gathering, would you try to talk to people
you had not met before? Based on a number of questions we devised a scale ranging
from 0 to 16 points, with scores closer to zero representing good quality of friendships.
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Adolescents in the SLI group ranged from 0 to 14 points while adolescents in the NLD
group had scores between 0 to 2. Overall, as a group, adolescents with SLI were at risk
of poorer quality of friendships.
We then examined predictors of friendships. Our results suggest that spoken
language abilities (expression and understanding of language) as well as literacy skills
(reading) were associated with friendship quality. But language was not the strongest
predictor, these were difficult behaviour and prosocial behaviour. We found that, in the
sample as a whole, language and literacy measures accounted for an additional 7% of
variance. Thus, language ability is predictive of adolescents’ friendship quality when
other behavioural characteristics known to be influential in peer relations (problem
behavior, prosocial behavior) are controlled for, but its overall influence is small. There
was also a small influence of nonverbal IQ. Thus, the predictor variables were, in order,
difficult behaviour, prosocial behaviour, language and literacy, and nonverbal IQ.
There was also evidence of variability in friendship quality, i.e. heterogeneity
within our sample of adolescents with SLI. The box below illustrates the fact that we find
a large proportion of adolescents with SLI that have good quality of friendships. In
Durkin and Conti-Ramsden (2007) factors that potentially distinguish between those with
good quality of friendships (60%) and those with poor quality of friendships (40%) are
examined in detail. Briefly, the findings suggest a marked developmental consistency in
the pattern of poor language for the poor friendships group across a 9 year span, from 7 to
16 years of age.
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● Six out of ten adolescents with SLI report good quality of friendships.
Specific language impairment itself appears to be a risk factor for poorer
friendship development. At the same time, there are individual differences in the nature
and severity of problems experienced. Although we found that the group of participants
with SLI as a whole scored less favorably on our measure of friendship quality, they also
showed considerable within-group heterogeneity, and many (60%) had good scores with
about 40% having poor quality of friendships. These data taken together suggest that poor
quality of friendships in SLI, although related to poor language, may not be simply a
consequence of the severity of the language problem experienced but is an additional
difficulty present in SLI, particularly evident during adolescence.
Emotional health
There have been some studies examining quality of life and psychiatric outcomes
in young people with SLI (Cantwell & Baker, 1987; Beitchman et al., 2001; Clegg et al.,
2005). Beitchman and colleagues followed up a group of children with SLI from 5 to 19
years and throughout this period they assessed them for the presence of possible
Good quality of friendships 60%
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psychiatric difficulties. They found that children with SLI were at greater risk of having
attention deficit hyperactivity disorders (Beitchman et al., 1996) and later had higher
rates of anxiety disorders (Beitchman et al., 2001), aggressive behaviour (Brownlie et al.,
2004) and higher levels of substance abuse (Beitchman et al., 2001). Clegg and
colleagues (2005) followed a cohort of children from 4 years to mid adulthood and found
greater risk of psychiatric impairment (compared to both peers and siblings), particularly
concerning depression, social anxiety and schizoform/personality disorders. Other studies
have examined language in populations referred primarily for psychiatric difficulties.
Cohen and colleagues (1998), for example, found a higher than expected rate of
undiagnosed language impairment (40%) in their clinic sample. In contrast, however, it
needs to be noted that a recent study of SLI (Snowling, Bishop, Stothard, Chipchase &
Kaplan, 2006) did not identify higher risk of emotional disorders at all. Thus, still
relatively little is known about the long-term emotional health outcomes for children with
SLI and the available literature yields somewhat mixed results. Therefore, we
investigated the occurrence of emotional symptoms such as anxiety and depression in our
cohort at 16 years of age (Conti-Ramsden & Botting, 2008).
As can be seen from Table 3, adolescents with SLI had higher scores for both
anxiety and depression. In addition, the proportion of adolescents scoring above the
clinical threshold was larger in the SLI group as compared to the NLD group for both
anxiety (12% vs. 2%) and depression (39% vs. 14%).
We then examined predictors of emotional health. Our results suggest that there
were virtually no associations between language ability and the development of
emotional health symptoms. Examination of earlier factors (at 7 years) suggests that
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those with emotional problems at 7 years also show increased anxiety at 16 years. Earlier
language once again showed remarkably few associations. Thus language was not a
predictor of emotional health in adolescents with SLI.
There was also evidence of variability in emotional health symptoms, i.e.
heterogeneity within our sample of adolescents with SLI. The box below illustrates the
fact that we find, amongst adolescents with SLI, a large proportion of individuals have
adequate emotional health.
●Nearly two-thirds of adolescents with SLI have little anxiety or depression symptoms.
In summary, the results of the above investigation raise a number of key issues
which relate to the risk of emotional health symptoms in young people with SLI. Firstly,
our data show a clear increased risk for this population as they near adulthood compared
to peers. This finding replicates other studies that have shown raised prevalence of
psychiatric difficulties in those with communication impairments (e.g., Clegg et al.,
2005) and increased language impairment in children referred psychiatrically (e.g.,
Cohen et al., 1998) and reviews affirming the association (Toppelberg & Shapiro, 2000).
Adequate mental health 60%
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Beitchman and colleagues (2001) in particular found increased anxiety in a similar cohort
with SLI at 19 years of age. The association has often been assumed to be causal in that
either long-term language impairment may lead to (or exacerbate) wider difficulties, or
that psychiatric impairment may constrain communication skill. However, apart from the
fact that those with SLI have increased symptoms, surprisingly few clear associations
have been identified between language and the development of emotional health
symptoms. This is similar to the findings of Clegg and colleagues (2005), who also failed
to find a clear relationship between the two. The lack of association with language scores
thus makes it more difficult to interpret the relationship between having poor language
and emotional health difficulties as a directly developmentally causal one: that is having
ongoing poor communicative experiences do not appear to ‘make you’ increasingly
depressed or anxious per se. Rather, the association appears to be with SLI itself, with
the disorder. Thus, other factors are likely to play a role in making some individuals
more vulnerable. From our own work we suggest these can range from family history of
anxiety and depression (Conti-Ramsden & Botting, 2008) to environmental factors such
as being bullied (Knox & Conti-Ramsden, 2007). Interestingly, poor quality of
friendships do not appear to be strongly associated with mental health difficulties. We
found that, in our sample, only 7% of adolescents showed difficulties in both friendships
and mental health; 32% showed difficulties with friendships in the context of adequate
mental health and 4% had the reverse pattern. Over half (57%) of the sample did not
show difficulties in either area.
What do Outcomes in Adolescence Tell Us About the Nature of SLI?
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The findings presented briefly above point to the heterogeneity in outcomes in
SLI. This heterogeneity is present within individuals as well as across individuals.
Within the individual, there appears to be variation in the constellation of difficulties an
individual may experience throughout development, in the severity of these difficulties,
and in the dynamic nature of these difficulties as these may not be stable across time.
Among those with SLI, different adolescents may have different types of difficulties of
different severity.
The concern that SLI is not a pure disorder of language is not a new idea (e.g.
Leonard 1987; 1991; 1998). What is perhaps debated but less well established is the
suggestions that we want to make here: that at least some of the associated difficulties
present in SLI are not directly related to the language difficulties present in SLI. We want
to argue that the heterogeneity observed in the outcomes of adolescents with SLI, both
within and across individuals, is a reflection of SLI being more than a language problem.
The evidence points to a need to redefine SLI.
SLI is a developmental disorder for which language is a primary manifestation in
early childhood. It is the case that there are a number of children (and not such a small
number, 5 to 7% is the estimated incidence amongst 5 year olds, Tomblin et al., 1997) of
pre-school age who present with primary language problems with other areas of
development apparently intact. The issue is that this profile of SLI does not remain this
way for long for a large proportion of children as they grow up. Other areas of
functioning may show deficits, including areas which can not be related directly to
language per se. SLI has associated difficulties which become more evident with
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development, only some of which are related to the severity and type of language
problem experienced.
In SLI the primary difficulty with language is assumed to hold the key to the
explanation as to why these children have these difficulties with language and other
areas. The evidence presented in this chapter in terms of outcomes at 16 years suggests
that factors other than difficulties with language may well be crucial in understanding the
range of outcomes that individuals with SLI experience throughout their childhood and
adolescence. In the specific case of our work on social interaction and friendship quality,
for example, it is important to bear in mind that language problems are not a guarantee of
social problems. Indeed, although social difficulties may distinguish children with SLI
from their typical peers, they are not usually in the clinical range (Botting & Conti-
Ramsden, 2000; Redmond & Rice, 1998). Children with SLI are heterogeneous in terms
of their language characteristics, and this holds true for their social abilities too: Some
children with SLI achieve high levels of peer popularity (Brinton & Fujiki, 2002; Fujiki
et al., 1999). In the evidence provided in this chapter, a very positive finding is that some
60% of adolescents with SLI had reported friendship quality in the good range. This
provides reassuring news that successful peer relations are indeed possible. While better
language ability contributes part of the explanation of these favourable outcomes, it is
clear that other factors are involved and that it is possible that strengths in one or more of
these can mitigate any effects due to impaired language.
In sum, our work with a large sample of individuals with SLI illustrates the wide
variation in outcomes observed in adolescence: from competent readers to very poor
readers; from those enjoying good quality of friendships to those with difficulties
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developing such relationships; from those experiencing anxiety and/or depressive
symptoms to those having adequate emotional health. This heterogeneity in outcomes
represents a challenge to researchers as well as practitioners. Further work is required on
the identification of factors affecting developmental trajectories of individuals with SLI
as well as on the development of supportive practice for the potentially changing needs of
individuals with SLI across their lifespan.
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Author Note
The authors gratefully acknowledge the support of the Nuffield Foundation
(grants AT 251 [OD], DIR/28 and EDU 8366), the Wellcome Trust (grant 060774), and
the Economic and Social Research Council (ESRC) for a fellowship to Gina Conti-
Ramsden (RES-063-27-0066). Correspondence concerning this chapter should be
addressed to Gina Conti-Ramsden, Human Communication and Deafness, School of
Psychological Sciences, The University of Manchester, Ellen Wilkinson Building,
Oxford Road, Manchester, M13 9PL UK. E-mail: [email protected]
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Table 1
Characteristics of adolescents with SLI and NLD (M, SD) at 16 years
Age Nonverbal
abilities (IQ)
Talking
(Language
expression)
Understanding
(Language
comprehension)
SLI 15;10 (0;5) 84.1 (18.8) 74.1 (11.0) 83.9 (16.9)
NLD 15;11 (0;4) 99.9 (15.8) 97.2 (15.0) 99.5 (13.2)
34
Table 2
Reading abilities in adolescents with SLI at 16 years
Mean (SD) standard score
for age
Percentage falling below
1SD from mean for age
Reading accuracy 83.4 (17.8) 49%
Reading comprehension 75.7 (14.3) 74%
35
Table 3
Anxiety and depression scores (M, SD) for adolescents with SLI and NLD adolescents at
16 years
Anxiety Depression
SLI 10.3 (6.1) 7.6 (5.5)
NLD 7.0 (4.0) 3.7 (4.2)