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Background: Public awareness of Developmental Language Disorder (DLD) is lower than other neurodevelopmental disorders, despite its high prevalence of 7.6%. This lower awareness means recruitment for DLD research studies is difficult. DLD is both underfunded and under-researched, resulting in relatively limited research investigating individuals with DLD. Engage with Developmental Language Disorder (E-DLD) is a response to these considerations. E-DLD is the first international participant database of those affected by DLD. Parents of children with DLD under 16 and young people and adults over 16 from anywhere in the world can sign up to be a part of the E-DLD., Aims: This paper aims to describe the families of children with DLD and adults with DLD in the database thus far., Methods & Procedures: E-DLD members sign up via our website, reporting demographic characteristics as part of this procedure. We request all E-DLD members subsequently fill in a yearly survey. The content of the yearly survey changes dependent on the age of the child, while the yearly survey for adults remains consistent. We measure a wide range of domains, such as speech and language therapy (SLT) support, school support, socialisation skills, and early developmental milestones for our youngest members, and health care support and mental well-being measurements for our adults. We also collect parent and self-reported reflections on strengths and challenges for the person with DLD using open-ended questions and the Strengths and Difficulties Questionnaire., Outcomes & Results: The database currently consists of 196 parents of children with DLD and 20 individuals over the age of 16 with DLD or suspected DLD across a range of socioeconomic status (SES) backgrounds. Our initial results confirm that E-DLD members meet the linguistic profile of DLD in relation to self- or parent-rated language difficulties. Both children and adults show increased rates of psychosocial difficulties compared to established norms, consistent with past research on clinical samples of people with DLD., Conclusions & Implications: The findings indicate that a participant database for DLD research is feasible and useful. The rates of emotional, behavioural and sleep difficulties among the child probands are higher than reported rates amongst typically developing children. Initial data indicate that adults with DLD have poorer well-being than their peers. The E-DLD is a useful collection of data on those affected by DLD and is a promising method for connecting people with DLD with academic researchers., What This Paper Adds: What is already known on this subject Developmental Language Disorder (DLD) is characterised by expressive and/or receptive language difficulties in the absence of another biomedical condition that could explain these difficulties. It is critically under-researched and underfunded. As such, there is a lack of public awareness and difficulty recruiting sufficient sample sizes for DLD research studies. What this paper adds to existing knowledge Engage with Developmental Language Disorder (E-DLD) is the first international participant database of individuals with DLD. This paper provides a preliminary report on the profile of linguistic and psychosocial skills among the individuals on the database, adding to current understanding of DLD across age groups. What are the potential or actual clinical implications of this work? Our aim is that the E-DLD will provide much-needed facilitation of research into DLD. E-DLD will enable those with DLD and their families more readily to shape research agendas and to participate in studies that interest them. Families may be recruited into research that could directly translate to better clinical treatment of DLD. We also believe that the E-DLD yearly survey holds potential to provide key information on the development and longitudinal experience of children and adults with DLD., (© 2022 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Background: There is extremely limited population-based research on social (pragmatic) communication disorder (SCD). Population-based samples have the potential to better characterize the SCD phenotype by mitigating confounds and biases that are typical of convenience and clinical samples., Aims: The aims of this preliminary epidemiologic study were to advance our understanding of the SCD phenotype relative to developmental language disorder (DLD), obtain an estimate of prevalence, identify risk factors and lay the groundwork for future population level research of SCD., Methods & Procedures: We analysed existing data from the EpiSLI Database to examine social communication skills in 393 8th grade (13-14 years) children with and without a history of DLD. The primary measure used to evaluate SCD was the Children's Communication Checklist (CCC-2). Two case definitions of SCD reflecting DSM-5 criteria were examined. Both definitions involved significant pragmatic impairment, employing a commonly adopted clinical cut-point of 1.5 SD. In one case, pragmatic deficits could occur along with structural language deficits and, in the other case (established using principal component analysis), pragmatic and social skills were disproportionately lower than structural language abilities., Outcomes & Results: When using the first case definition, SCD was much more common in children with a history of DLD than without DLD and history of language disorder at kindergarten was a significant risk factor for SCD in adolescence. However, it is important to note that SCD could be found in children with no prior deficits in other aspects of language. When the second definition was employed, SCD was equally distributed across children with and without a history of DLD. Male sex was a significant risk factor using this case definition of SCD. The estimated prevalence of SCD ranged from 7% (SE = 1.5%) to 11% (SE = 1.7%), acknowledging that prevalence depends on the cut-point selected to determine communication disorder., Conclusions & Implications: These findings contribute to our understanding of the association between SCD and DLD by recognizing varying profiles of pragmatic and social communication difficulties, which in turn may help refine our diagnostic categories. Preliminary prevalence estimates of SCD can serve as an initial guidepost for identification and planning for intervention services for this condition., What This Paper Adds: What is already known on this subject There is considerable debate about the diagnostic category of SCD and its relation to other neurodevelopmental disorders. What this study adds to existing knowledge Using data from a US-based epidemiologic sample of DLD, this study offers new information about the association between SCD and DLD, provides preliminary estimates of SCD prevalence, and identifies risk factors for SCD. Clinical implications of this study Improved understanding of possible profiles of pragmatic and social communication deficits will help to clarify diagnostic categories and preliminary prevalence estimates may assist with ensuring availability of adequate intervention services., (© 2021 Royal College of Speech and Language Therapists.)

Background: Early reading success is predicated on language and pre-literacy skills. Children who are behind their peers in language and pre-literacy development before formal schooling are less likely to be proficient beginner readers, and difficulties may persist throughout primary school and beyond. We know children experiencing adversity are at greater risk of early language and pre-literacy difficulties; we do not know the prevalence of these difficulties in an Australian adversity context., Aims: To investigate the prevalence and co-occurrence of language and pre-literacy difficulties in a cohort of Australian 5-year-old children experiencing social adversity., Methods & Procedures: Data were drawn from a large Australian community-based trial of nurse home visiting (right@home), which aimed to support women experiencing social adversity from pregnancy until their child turned 2 years of age. Social adversity was determined by two of more risk factors: young pregnancy, not living with another adult, no support, poorer health, current smoker, long-term illness, anxious mood, not finishing high school, no household income and no previous employment. Children whose mothers were enrolled in the control group (receiving usual maternal and child healthcare) were included in the current study (n = 359). Language and pre-literacy skills were measured at age 5 using the Clinical Evaluation of Language Fundamental Preschool-Second Edition (CELF-P2) and the School Entry Alphabetic and Phonological Awareness Readiness Test (SEAPART). Language difficulties were defined as ≥ 1.25 standard deviations (SD) below the Australian normative mean on CELF-P2 Core Language scores. Pre-literacy difficulties were defined as children scoring in the Beginner (versus Developing or Competent) criterion-referenced level on the SEAPART First Sound Identification and/or Alphabet Letter Identification subtests. Co-occurrence of language and pre-literacy difficulties was also determined., Outcomes & Results: At the 5-year follow-up, 201/359 (56%) children were assessed (mean age = 5.1 years, SD = 0.1). Mean Core Language score for this cohort (91.8, SD = 15.9) was 0.54 SD below the normative mean (100, SD = 15). The proportion of children presenting with language difficulties was 24.9%. Regarding pre-literacy skills, 43.8% of children were 'Beginner' for identifying first sounds and 58.6% for identifying alphabet letters/sounds. There was also considerable overlap whereby 76.7% of children with language difficulties also exhibited pre-literacy difficulties., Conclusions & Implications: This is the first empirical Australian-based study highlighting the high prevalence and co-occurrence of language and pre-literacy difficulties in preschool children experiencing social adversity. Clinicians should be aware of co-morbid language and pre-literacy difficulties in disadvantaged populations and consider both areas during assessment and intervention planning. What this paper adds What is already known on the subject The prevalence of language and literacy difficulties is substantially higher in cohorts experiencing social adversity when compared with more advantaged families. There is some evidence that adversity also contributes to pre-literacy difficulties, but less is known here. What this paper adds to existing knowledge This study presents new prevalence data showing high rates of language and pre-literacy difficulties for 5-year-old children experiencing adversity within an Australian context. It is the first to explore these skills in a large cohort of pre-schoolers recruited from community settings in Australia. What are the potential or actual clinical implications of this work? In this cohort experiencing adversity, most children who presented with language difficulties likewise exhibited pre-literacy difficulties. This concordance reflects how early oral language and pre-literacy skills develop together. Clinicians should assess both skills in preschool populations-especially those working with children experiencing adversity-to ensure all children have strong foundations to become proficient beginner readers., (© 2021 Royal College of Speech and Language Therapists.)

Background: Early detection and remediation of language disorders are important in helping children to establish appropriate communicative and social behaviour and acquire additional information about the world through the use of language. In the Netherlands, children with (a suspicion of) language disorders are referred to speech and hearing centres for multidisciplinary assessment. Reliable data are needed on the nature of language disorders, as well as the age and source of referral, and the effects of cultural and socioeconomic profiles of the population served in order to plan speech and language therapy service provision., Aims: To provide a detailed description of caseload characteristics of children referred with a possible language disorder by generating more understanding of factors that might influence early identification., Methods & Procedures: A database of 11,450 children was analysed consisting of data on children, aged 2-7 years (70% boys, 30% girls), visiting Dutch speech and hearing centres. The factors analysed were age of referral, ratio of boys to girls, mono- and bilingualism, nature of the language delay, and language profile of the children., Outcomes & Results: Results revealed an age bias in the referral of children with language disorders. On average, boys were referred 5 months earlier than girls, and monolingual children were referred 3 months earlier than bilingual children. In addition, bilingual children seemed to have more complex problems at referral than monolingual children. They more often had both a disorder in both receptive and expressive language, and a language disorder with additional (developmental) problems., Conclusions & Implications: This study revealed a bias in age of referral of young children with language disorders. The results implicate the need for objective language screening instruments and the need to increase the awareness of staff in primary child healthcare of red flags in language development of girls and multilingual children aiming at earlier identification of language disorders in these children. What this paper adds What is already known on the subject Identifying language disorders before children enter school can foster the initiation of early interventions before these problems interfere with formal education and behavioural adjustment. Information on caseload characteristics is important to plan speech and language therapy service provision. There are only a few studies on the caseload characteristics of children at first referral for language assessment. What this paper adds to existing knowledge This study provides a detailed description of the caseload characteristics of children referred to Dutch speech and hearing centres. The results reveal an age bias in referral: boys were referred earlier than girls, and monolingual children were revealed earlier than bilingual children. On top of that, bilingual children seemed to have more complex problems at referral. What are the potential or actual clinical implications of this work? This study indicates that it is important to be aware of bias in the age of referral of subgroups of children with language disorders. Solutions might be to implement a language screening instrument designed for use by non-speech-language therapists, and training in early recognition of girls and multilingual children with (less complex) language disorders for health professionals in key positions in child healthcare. In addition, it might be worthwhile to assign speech and language therapists with diverse ethnic and language backgrounds and/or with experience with bilingual/cultural children in a regional mentoring function to support referral agents and parents., (© 2020 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Background: It has been reported that the inhabitants of the Chilean Robinson Crusoe Island have an increased frequency of specific language impairment (SLI) or developmental language disorder (DLD)., Aims: To explore the familial aggregation of DLD in this community., Methods & Procedures: We assessed the frequency of DLD amongst colonial children between the ages of 3 and 8;11 years (50 individuals from 45 nuclear families). Familial aggregation rates of language disorder were calculated by assessing all available first-degree relatives (n = 107, 77 parents, 25 siblings, five half-siblings) of the probands., Outcomes & Results: We found that 71% of the child population performed significantly below expected in measures of phonological production or expressive and receptive morphology. The majority of these children presented with severe expressive and/or receptive language difficulties. One-quarter of language-disordered probands primarily had phonological difficulties. Family members of affected probands experienced a higher risk of language disorder than those of typically developing probands. This increased risk was apparent regardless of non-verbal IQ., Conclusions & Implications: The study substantiates the existence of a familial form of speech and language disorder on Robinson Crusoe Island. Furthermore, we find that the familiarity is stable regardless of non-verbal IQ, supporting the recent movement to reduce the importance of non-verbal IQ criterion in DLD diagnoses., (© 2018 Royal College of Speech and Language Therapists.)

Background: Developmental language disorder (DLD) presents a considerable barrier for young adults to engage in further education and training. Early studies with young adults with DLD revealed poor educational achievement and lack of opportunities to progress in education. More recent studies have provided more positive findings. Relatively sparse data exist, however, on current cohorts and the factors that predict outcomes., Aims: To examine educational and employment outcomes in young adulthood in a sample of people with histories of DLD compared with an age-matched peer group without DLD. We ask: How do educational pathways and early jobs compare between those with and without DLD? Are young adults with DLD receiving similar levels of income as their peers? To what extent are language and literacy abilities associated with outcomes?, Methods & Procedures: Participants included 84 individuals with DLD (67% males) and 88 age-matched peers without DLD (56% males). Participants were on average 24 years of age. They completed a battery of psycholinguistic, literacy and nonverbal skills assessments. Data were also collected on educational qualifications, current educational status, extent of educational support received, employment status, history and support, as well as current income., Outcomes & Results: Those with DLD obtained lower academic and vocational qualifications. Higher educational/vocational qualifications were associated with better language, better reading and higher performance IQ (PIQ). There were few differences between the two groups in terms of engagement with education, but the mean age at leaving education was significantly earlier in the participants with DLD. Substantially more participants with DLD reported receiving support or dispensation from their educational institution. There was no significant difference between groups in the proportion of young people currently employed, though a higher proportion of the age-matched peers was in work full time. Participants with DLD were much more likely to be in non-professional occupations. However, when examining pay in relation to types of occupation, the groups' incomes were broadly comparable., Conclusions & Implications: At the group level, young people with a history of DLD more commonly have less skilled employment and more rarely achieve professional roles. At the individual level there is considerable variation with smaller but not trivial proportions of young adults with a history of DLD showing good educational and employment outcomes. There are positive aspects to early adult outcomes for some young people with a history of DLD., (© 2017 The Authors International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Background: There is now substantial literature demonstrating that a disproportionate number of young people who come into contact with youth justice services evidence unidentified language difficulties. These young people, therefore, have received little or no professional input in this area. Conversely, there is a dearth of research pertaining to criminality outcomes among those individuals with identified developmental language disorders (DLD) who have received such interventions., Aims: To examine police-initiated contact and substance use outcomes of young adults with a history of identified DLD versus age-matched peers (AMP). Additionally, self-reported rule breaking behaviours and aggression are considered. We hypothesize that early identification/intervention reduces engagement with risky behaviour such as substance and alcohol use as well as offending-related behaviours., Methods & Procedures: Adversarial police-initiated contacts were examined in 84 young adults with a history of DLD and 88 AMP. Rule-breaking and aggression were evaluated using the Achenbach Adult Self-Report for ages 18-59 years., Outcomes & Results: Adults with a history of DLD who received targeted intervention during their school years reported less contact with their local police service compared with AMPs at age 24. Comparable proportions of both groups reported current alcohol consumption, but group differences were found relating to alcohol use. No group differences in rule-breaking behaviours were found, but the DLD group was found to have a statistically significant higher raw score on the aggressive behaviour scale., Conclusions & Implications: There is a need for early identification of children with DLD. Early intervention aimed at ameliorating such difficulties could possibly have distal outcomes in relation to offending., (© 2017 The Authors International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Background: Evidence suggests that language and social, emotional and behavioural (SEB) difficulties are associated in children and adolescents. When these associations emerge and whether they differ by language or SEB difficulty profile is unclear. This knowledge is crucial to guide prevention and intervention programmes for children with language and SEB difficulties., Aims: To determine whether receptive and expressive language skills are associated with internalizing and externalizing behaviours in slow-to-talk toddlers., Methods & Procedures: In a community-based prospective study of 200 slow-to-talk children, language was measured at 24 and 36 months using Preschool Language Scale 4th Edition and at 48 months using Clinical Evaluation of Language Fundamentals-Preschool 2nd Edition. Internalizing and externalizing behaviours were measured by parent report at each age. Longitudinal data were analysed using repeated-measures regression, with up to three observations per child. Robust standard errors were used to account for non-independence of measures within participants. The shape of the associations were examined by fitting quadratic and cubic terms. The effects of confounders on the associations were examined., Outcomes & Results: Receptive language had a negative linear association with internalizing behaviours after adjusting for confounders (β = -0.16, 95% [CI = -0.26, -0.07], p = .001); and a negative curved association with externalizing behaviours after adjusting for biological confounders (β quadratic = 0.08 [0.01, 0.15], p = .03, β cubic = -0.04 [-0.07, -0.02], p = .001), attenuating after adjusting for environmental confounders (β quadratic = 0.06 [-0.01, 0.13], p = .09, β cubic = -0.03 [-0.06, -0.003], p = .03). The curvature suggests that the negative association with externalizing behaviours only existed for children with either very low or very high receptive language scores. After controlling for confounders, there was no evidence that expressive language scores were associated with internalizing (β = -0.08, 95% [CI = -0.17, 0.01], p = .10) or externalizing behaviours (β = 0.03, 95% [CI = -0.09, 0.18], p = .61). Tests of interaction revealed no evidence of a differential association by age., Conclusions & Implications: In 24-48-month-old slow-to-talk children, lower receptive language scores were associated with higher internalizing behaviours. The magnitude of the association was small. For children with very poor receptive language scores, lower receptive language skills were associated with higher externalizing behaviours. Young children with low receptive language abilities may be at risk of internalizing difficulties; those with very low receptive language skills may be at particular risk of externalizing difficulties. This has clinical implications for interventions for young children with receptive language difficulties., (© 2017 Royal College of Speech and Language Therapists.)

Background: Population-based studies have found that early language delays are associated with poorer long-term outcomes in adolescence and adulthood. Few studies have explored the influence of change in language ability over time on adult outcomes., Aim: To examine the educational, vocational and mental health outcomes for adults accounting for different vocabulary developmental profiles over a 16-year period., Methods & Procedures: A total of 1914 participants of the Mater-University of Queensland Study of Pregnancy (MUSP) were categorized into four groups based on their vocabulary skills at 5 and 21 years: (1) persistently good (n = 1679), (2) persistently poor (n = 33), (3) improved (n = 160), and (4) deteriorated (n = 42). The associations between vocabulary group and educational, vocational, and mental health outcomes at 21 years were investigated., Outcomes & Results: Adults with deteriorated and persistently poor vocabulary skills were less likely to have completed secondary school; with the improved, deteriorated and persistently poor groups being less likely to be engaged in education, employment or training at the 21-year follow-up, compared with the persistently good group. Adults with deteriorated performance were at an increased risk of affective disorders, as well as substance and alcohol abuse/misuse., Conclusions & Implications: These findings provide evidence that impaired vocabulary skills in adulthood, regardless of whether the deficit was acquired early or later, are associated with adverse outcomes. Clinicians and educators need to be aware of these adversities and ensure they are supporting children and adolescents in whom language difficulties exist or emerge so as to prevent poor long-term outcomes from occurring., (© 2016 Royal College of Speech and Language Therapists.)

Background: Well-documented associations exist between socio-economic background and language ability in early childhood, and between educational attainment and language ability in children with clinically referred language impairment. However, very little research has looked at the associations between language ability, educational attainment and socio-economic background during adolescence, particularly in populations without language impairment., Aims: To investigate: (1) whether adolescents with higher educational outcomes overall had higher language abilities; and (2) associations between adolescent language ability, socio-economic background and educational outcomes, specifically in relation to Mathematics, English Language and English Literature GCSE grade., Method & Procedures: A total of 151 participants completed five standardized language assessments measuring vocabulary, comprehension of sentences and spoken paragraphs, and narrative skills and one nonverbal assessment when between 13 and 14 years old. These data were compared with the participants' educational achievement obtained upon leaving secondary education (16 years old). Univariate logistic regressions were employed to identify those language assessments and demographic factors that were associated with achieving a targeted A * -C grade in English Language, English Literature and Mathematics General Certificate of Secondary Education (GCSE) at 16 years. Further logistic regressions were then conducted to examine further the contribution of socio-economic background and spoken language skills in the multivariate models., Results & Outcomes: Vocabulary, comprehension of sentences and spoken paragraphs, and mean length utterance in a narrative task along with socio-economic background contributed to whether participants achieved an A * -C grade in GCSE Mathematics and English Language and English Literature. Nonverbal ability contributed to English Language and Mathematics. The results of multivariate logistic regressions then found that vocabulary skills were particularly relevant to all three GCSE outcomes. Socio-economic background only remained important for English Language, once language assessment scores and demographic information were considered., Conclusions & Implications: Language ability, and in particular vocabulary, plays an important role for educational achievement. Results confirm a need for ongoing support for spoken language ability throughout secondary education and a potential role for speech and language therapy provision in the continuing drive to reduce the gap in educational attainment between groups from differing socio-economic backgrounds., (© 2016 Royal College of Speech and Language Therapists.)

Background: The prevalence of speech-language impairments in children have been estimated for several languages, primarily in developed countries. However, prevalence data is lacking for developing countries, such as Nepal., Aims: (1) To obtain teacher estimates of incidence and overall prevalence of speech-language impairments and its subtypes as a function of gender, age and grade level; and (2) to validate the screening instrument on Nepalese children., Methodology: The adapted teachers' screening instrument, namely adapted Teachers' Speech and Language Referral Checklist (a-TSLRC), was administered in 2776 (690 and 2086) primary school children aged 5;00-11;11 years (mean = 8;11 years). The screening was conducted at four different points in time, i.e. Incidences I and II, and each incidence consisted of a testing and a retesting phase. Prior to this, teachers were trained in forum meetings, and an information sheet containing an overview of speech-language impairments, and guidelines/criteria for marking the occurrence of speech-language impairments in the TSLRC were disseminated., Outcomes & Results: Overall prevalence of speech-language impairments in children was estimated as 8.11%. Specifically, overall speech problems were estimated as 4.68%, and language problems as 8.0%. Additionally, the prevalence by subtypes of speech-language impairments as categorized in the TSLRC were reported to be 2.95% for an articulation/phonological problems, 2.09% for stuttering, 3.42% for a voice problems, 4.97% for a receptive language problems and 7.74% for an expressive language problems. The internal consistency among items was sufficient and a good intra-rater reliability was obtained., Conclusions & Implications: The study indicates that the overall results of speech-language impairments in children via the adapted in-Nepalese criterion-referenced instrument are supported by international studies. In addition, justifiable reliability and validity was obtained. Therefore, based on these overall evidence, this instrument can be useful for the screening of speech-language impairments in primary school children in Nepal., (© 2016 Royal College of Speech and Language Therapists.)

Background: Although it is well-established that children with language impairment (LI) and children with autism spectrum disorders (ASD) both show elevated levels of emotional and behavioural problems, the level and types of difficulties across the two groups have not previously been directly compared., Aims: To compare levels of emotional and behavioural problems in children with LI and children with ASD recruited from the same mainstream schools., Methods & Procedures: We measured teacher-reported emotional and behavioural problems using the Strengths and Difficulties Questionnaire (SDQ) in a sample of 5-13-year-old children with LI (N = 62) and children with ASD (N = 42) attending mainstream school but with identified special educational needs., Outcomes & Results: Both groups showed similarly elevated levels of emotional, conduct and hyperactivity problems. The only differences between the LI and ASD groups were on subscales assessing peer problems (which were higher in the ASD group) and prosocial behaviours (which were higher in the LI group). Overall, there were few associations between emotional and behavioural problems and child characteristics, reflecting the pervasive nature of these difficulties in children with LI and children with ASD, although levels of problems were higher in children with ASD with lower language ability. However, in the ASD group only, a measure of family social economic status was associated with language ability and attenuated the association between language ability and emotional and behavioural problems., Conclusions & Implications: Children with LI and children with ASD in mainstream school show similarly elevated levels of emotional and behavioural problems, which require monitoring and may benefit from intervention. Further work is required to identify the child, family and situational factors that place children with LI and children with ASD at risk of emotional and behavioural problems, and whether these differ between the two groups. This work can then guide the application of evidence-based interventions to these children., (© 2014 Royal College of Speech and Language Therapists.)

Background: Identifying 3-4-year-olds who are most at risk of persisting language difficulties, and possibly specific language impairment (SLI), is difficult due to the natural variation of language in young children. In older children, markers for SLI have been identified that differentiate between children with and without SLI. It is not known whether these markers can be used at an earlier age to identify children most at risk of persisting language difficulties., Aims: To identify possible risk markers of current status that distinguish children who have specific expressive language delay (SELD) from the variation observed in normally developing children at age 3;0-4;0 and 4;0-5;0. To determine the most suitable measure(s) that would predict which children with SELD at age 3;0-4;0 were likely to have persistent expressive language delay (PELD) at age 4;0-5;0., Methods & Procedures: Forty-seven children with SELD and 47 children with typical language development (TLD) were assessed on language, nonverbal IQ and marker tasks at age 3;0-4;0 (baseline). Ninety-one children were reassessed on the measures one year later (follow-up). At both time points, the marker tasks were compared with a reference standard (Expressive Communication subscale (EC) of the Preschool Language Scale-3 (PLS-3) (UK)) to determine the most useful marker for identifying children with SELD. Possible predictors were examined to determine the most suitable measure(s) that would predict which children with SELD at baseline were likely to have PELD at follow-up., Outcome & Results: A modified version of Recalling Sentences, a subtest of the Clinical Evaluation of Language Fundamentals (CELF)-Preschool UK, was the most useful marker for identifying children with SELD at baseline and at follow-up. Thirty-five (76.1%) of the 46 children with SELD at baseline had PELD at follow-up. Performance on the Auditory Comprehension (AC) and EC subscales of the PLS-3 (UK) and on modified Recalling Sentences at age 3;0-4;0 were predictors of PELD at age 4;0-5;0., Conclusions & Implications: A modified Recalling Sentences task was a good risk marker for SELD at age 3;0-4;0 and SELD at age 4;0-5;0. PLS-3 AC, PLS-3 EC and modified Recalling Sentences at baseline were the best predictors of PELD. The use of modified Recalling Sentences as a predictive marker requires confirmation., (© 2013 Royal College of Speech and Language Therapists.)

Background: Several studies in recent years have indicated a link between socio-economic status (SES) of families and children's language development, including studies that have measured children's language through formal standardized test procedures. High numbers of children with low performance have been found in lower socio-economic groups in some studies. This has proved a cause for concern for both clinicians and educationalists., Aims: To investigate the relationship between maternal education and postcode-related indicators of SES, and children's performance on the New Reynell Developmental Scales (NRDLS)., Methods & Procedures: Participants were 1266 children aged between 2;00 and 7;06 years who were recruited for the standardization of a new assessment procedure (NRDLS). Children were divided into four groups reflecting years of maternal education, and five groups reflecting SES Index of Multiple Deprivation (IMD) quintiles for the location of participating schools and nurseries. Groups were compared using analysis of covariance (ANCOVA), with age as a covariate, in order to identify which might be affected by the two SES variables. Where relationships were found between SES and performance on the scales, individual children's standard scores were looked at to determine numbers potentially at risk for language delay., Outcomes & Results: An effect of years of maternal education on performance was found such that children whose mothers had minimum years performed less well than other children in the study, this effect being stronger for younger children. Children attending schools or nurseries in IMD quintile 1 areas performed less well in language production. Higher than expected numbers with language delay were found for younger children whose mothers had minimum years of education, and for children in quintile 1 schools and nurseries; however, numbers were not as high as noted in some other studies., Conclusions & Implications: Characteristics of the participant sample and measures used for language and SES may explain these results and are important considerations when interpreting results of studies or developing policies for intervention. The usefulness of commonly used categories of language delay is questioned., (© 2013 Royal College of Speech and Language Therapists.)

Background: Children with speech sound disorders (SSD) form a heterogeneous group who differ in terms of the severity of their condition, underlying cause, speech errors, involvement of other aspects of the linguistic system and treatment response. To date there is no universal and agreed-upon classification system. Instead, a number of theoretically differing classification systems have been proposed based on either an aetiological (medical) approach, a descriptive-linguistic approach or a processing approach., Aims: To describe and review the supporting evidence, and to provide a critical evaluation of the current childhood SSD classification systems., Methods & Procedures: Descriptions of the major specific approaches to classification are reviewed and research papers supporting the reliability and validity of the systems are evaluated., Main Contribution: Three specific paediatric SSD classification systems; the aetiologic-based Speech Disorders Classification System, the descriptive-linguistic Differential Diagnosis system, and the processing-based Psycholinguistic Framework are identified as potentially useful in classifying children with SSD into homogeneous subgroups. The Differential Diagnosis system has a growing body of empirical support from clinical population studies, across language error pattern studies and treatment efficacy studies. The Speech Disorders Classification System is currently a research tool with eight proposed subgroups. The Psycholinguistic Framework is a potential bridge to linking cause and surface level speech errors., Conclusions & Implications: There is a need for a universally agreed-upon classification system that is useful to clinicians and researchers. The resulting classification system needs to be robust, reliable and valid. A universal classification system would allow for improved tailoring of treatments to subgroups of SSD which may, in turn, lead to improved treatment efficacy., (© 2012 Royal College of Speech and Language Therapists.)

This survey study investigates issues related to bilingualism and autism. Bilingualism is common around the world but there is little published information to guide professionals and parents in making decisions about bilingualism for children with autism. Participants were 49 parents or guardians of children with autism who were members of a bilingual family; 75% were raising their child with autism spectrum disorders (ASD) to be bilingual or multilingual. Professionals did not always support this choice. Parents reported that living in a bilingual community and the need to communicate with various people in a variety of venues supported a bilingual choice along with the enrichment and job opportunities that bilingualism afforded. Parents also reported concerns around choosing bilingualism for their children with ASD, such as lack of services and supports and concerns about whether their children would be able to learn two languages. Children with ASD exposed to two languages were often reported to be acquiring their languages of exposure, albeit to varying degrees. Given the small sample size and the exploratory nature of the study, the need for more research is emphasized., (© 2011 Royal College of Speech and Language Therapists.)

Aims: This study investigated the long-term consequences of language impairments for academic, educational and socio-economic outcomes. It also assessed the unique contributions of childhood measures of speech and language, non-verbal IQ, and of psychiatric and neurological problems., Methods & Procedures: The study was a 30-year follow-up of 198 participants originally diagnosed with language impairments at 3-9 years. Childhood diagnoses were based on language and cognitive abilities, social maturity, motor development, and psychiatric and neurological signs. At follow-up the participants responded to a questionnaire about literacy, education, employment, economic independence and family status. The response rate was 42% (198/470)., Outcomes & Results: At follow-up a majority of the participants reported literacy difficulties, unemployment and low socio-economic status-at rates significantly higher than in the general population. Participants diagnosed as children with specific language impairments had significantly better outcomes than those with additional diagnoses, even when non-verbal IQ was normal or statistically controlled. Childhood measures accounted for up to 52% of the variance in adult outcomes., Conclusions & Implications: Psychiatric and neurological comorbidity is relevant for adult outcomes of language impairments even when non-verbal IQ is normal., (© 2011 Royal College of Speech & Language Therapists.)

Background & Aims: In order to understand better the lexical access abilities in children with word-finding difficulties, the extent of serial naming speed difficulties in these children as well as the degree to which serial and discrete naming tasks are related to one another and to literacy abilities was investigated. This enabled some of the predictions made in the double-deficit hypothesis of Wolf and Bowers to be tested., Methods & Procedures: Eighteen children with word-finding difficulties completed naming and literacy tasks at 8;6 years and literacy tasks at 9;8 years., Outcomes & Results: Children with word-finding difficulties had very slow serial naming, despite their non-verbal and literacy abilities often being in the typical range. Serial and discrete naming speeds were not closely related. The performance on serial naming tasks that involved alphanumeric items provided the strongest correlations with decoding and reading comprehension., Conclusions & Implications: Discrete and serial naming tasks appear to assess different aspects of lexical access, and only partial support was obtained for the double-deficit hypothesis. The findings also suggest that a reason for the correlation between the children's serial naming speed for letters/digits and their literacy could be because both are structurally similar tasks., (© 2011 Royal College of Speech & Language Therapists.)

Background: Relationships between child language development and temperament have been little studied in young children, although it is known that children with language impairment are at risk in a number of domains of psychosocial development involving temperamental influences., Aims: To investigate the relationships between temperament and language development, along with child behavioural adjustment and maternal psychosocial factors., Methods & Procedures: A sample of 4-year-old children with language impairment was compared with typically developing children, from a large community cohort in a longitudinal study, on three temperament dimensions, behavioural and emotional problems, and maternal factors. Participants were part of a large community cohort involved in a longitudinal study., Outcomes & Results: While the groups did not differ significantly on temperamental shyness/sociability, children with language impairment showed more negative dispositions on the persistence/self-regulation factor, and on overall temperamental difficultness. Behavioural problems were elevated in the language impairment group and were associated with temperament in both groups. Maternal measures of education level, reading and vocabulary skills were significantly lower in the language impairment group., Conclusions & Implications: Generally the language impairment group showed a constellation of developmental disadvantages which add to the existing developmental vulnerability conferred by the presence of language impairment. Poorer child temperament self-regulation and behavioural adjustment are strong risk factors for school learning, while lower mother education and literacy contribute further disadvantage. Clinicians managing language impairment in children need to be aware of the whole package of risk factors which are common in this population., (© 2011 Royal College of Speech and Language Therapists.)

Background: Although children with Down's syndrome show some delays in each area of language development, their morphosyntactic competence appears to be more severely compromised than their lexical skills and, therefore, they are frequently mentioned as an example of dissociation between grammar and lexicon., Aims: The principal aim of the present study was to compare the lexical and syntactic development of Italian children with Down's syndrome with that of typically developing children, considering their spontaneous production. Particular attention was given to the relationships between these linguistic areas and the transition from single-word utterances to multiword combinations (that is, transitional forms)., Methods & Procedures: Twenty-four children participated in the study: twelve with Down's syndrome and twelve typically developing children. On average, the children with Down's syndrome participating in the study had a vocabulary size of about 450 words; and their mean chronological age was 54 months, whereas their mean developmental age was 30 months. The criteria for inclusion in the typically developing children group were a mean vocabulary size similar to that of the participants with Down's syndrome and a mean chronological age equivalent to the mean developmental age of the children with Down's syndrome. Each child's spontaneous verbal production was assessed during a parent-child play session. Data analyses focused on both lexical variables (type and tokens, vocabulary composition) and syntactic variables (frequency and types of transitional forms, frequency of utterances with different degree of complexity, and argument structure of verbs)., Outcomes & Results: The vocabulary composition of the children with Down's syndrome appeared to be simpler than that of the typically developing children at the same lexical size. Children with Down's syndrome used a higher number of transitional forms, but their production of multi-word utterances was less frequent; they were able to use word combinations, but they produced a low number of morphologically complete sentences. In addition, a significant relationship emerged between the development of the lexicon and the production of multi-word utterances., Conclusions & Implications: Children with Down's syndrome seem to have greater difficulties in expressing sentences in a grammatically correct form, though they are able to combine words. The theoretical relevance of the study lies in the fact that individuating a significant relationship between lexical and syntactic skills supports the hypothesis of interdependence between these two language domains; the practical relevance of the results lies in the fact that intervening on lexical abilities could have a beneficial effect on syntactic skills., (© 2010 Royal College of Speech & Language Therapists.)

There has been a long-standing interest in the relationship between specific language impairment (SLI) and autism spectrum disorder (ASD). In the last decade Tager-Flusberg and colleagues have proposed that this relationship consists of a partial overlap between the two. Therefore, among children with ASD there exists a subgroup who have SLI and ASD which has been called 'ALI'. Tager-Flusberg's laboratory has presented several papers showing similar language profiles and brain structure abnormalities in both SLI and ALI. Others (Bishop, Whitehouse, Botting, Williams) have been less convinced that these ALI children have both ASD and SLI. Although they generally agree that the two groups are grossly similar, careful inspection of the data shows that there are differences. I will argue that many of the problems in this debate stem from a view of SLI that represents a particular kind of language learner and therefore a particular and unique profile can be assumed. I argue for recognizing that SLI is not likely to be a unique kind of language learner. Many of the features reported to be characteristic of SLI are also found in other forms of neurodevelopmental disorders. Other features are the outgrowth of studying clinically identified children with SLI and thus the profile appears to reflect biases and practices in the clinical service system. As a result it may be more reasonable to conclude that there is a large group of children with ASD who have poor language skills. The question then remains why are there so many children with ASD who also have poor language? There are several factors that collectively are strong candidates for answers to this question., (© 2011 Royal College of Speech & Language Therapists.)

Background: Increasing numbers of children with behaviour and school problems (related to both academic achievement and social participation) are recognized as having undiagnosed speech, language and communication difficulties. Both speech, language and communication difficulties and school failure are risk factors for offending., Aims: To investigate the prevalence of speech, language and communication difficulties in a group of persistent and prolific young offenders sentenced to the Intensive Supervision and Surveillance Programme (ISSP), and to provide a preliminary evaluation of the impact of speech and language therapy (SLT) intervention., Methods & Procedures: Seventy-two entrants to ISSP over 12 months were screened by the speech and language therapist. Those showing difficulties then had a detailed language assessment followed by intervention delivered jointly by the speech and language therapist and the youth offending team staff. Reassessment occurred at programme completion., Outcomes & Results: A total of 65% of those screened had profiles indicating that they had language difficulties and might benefit from speech and language therapy intervention. As a cohort, their language skills were lower than those of the general population, and 20% scored at the 'severely delayed' level on standardized assessment. This is the first study of speech and language therapy within community services for young offenders, and is the first to demonstrate language improvement detectable on standardized language tests. However, further research is needed to determine the precise role of speech and language therapy within the intervention programme., Conclusions & Implications: Children and young people with behavioural or school difficulties coming into contact with criminal justice, mental health, psychiatric, and social care services need to be systematically assessed for undiagnosed speech, language and communication difficulties. Appropriate interventions can then enable the young person to engage with verbally mediated interventions., (© 2011 Royal College of Speech & Language Therapists.)

Background: The UK government set up a review of provision for children and young people with the full range of speech, language and communication needs led by a Member of Parliament, John Bercow. A research study was commissioned to provide empirical evidence to inform the Bercow Review., Aims: To examine the efficiency and effectiveness of different arrangements for organizing and providing services for children and young people with needs associated with primary speech, language and communication difficulties., Methods & Procedures: Six Local Authorities in England and associated Primary Care Trusts were selected to represent a range of locations reflecting geographic spread, urban/rural and prevalence of children with speech, language and communication difficulties. In each case study, interviews were held with the senior Local Authority manager for special educational needs and a Primary Care Trust senior manager for speech and language therapy. A further 23 head teachers or heads of specialist provision for speech, language and communication difficulties were also interviewed and policy documents were examined., Outcomes & Results: A thematic analysis of the interviews produced four main themes: identification of children and young people with speech, language and communication difficulties; meeting their needs; monitoring and evaluation; and research and evaluation. There were important differences between Local Authorities and Primary Care Trusts in the collection, analysis and use of data, in particular. There were also differences between Local Authority/Primary Care Trust pairs, especially in the degree to which they collaborated in developing policy and implementing practice., Conclusions & Implications: This study has demonstrated a lack of consistency across Local Authorities and Primary Care Trusts. Optimizing provision to meet the needs of children and young people with speech, language and communication difficulties will require concerted action, with leadership from central government. The study was used by the Bercow Review whose recommendations have been addressed by central government and a funded action plan has been implemented as a result.

Background: Specific language impairment (SLI) is diagnosed when a child shows isolated structural language problems. The diagnosis of pragmatic language impairment (PLI) is given to children who show difficulties with the use of language in context. Unlike children with SLI, these children tend to show relatively intact structural language skills while they do exhibit clear communicative deficits. There is hardly any research on the relationship between pragmatic competence and behavioural problems. Existing research suggests a strong relationship, but has only been executed on clinical SLI samples. Moreover, it is not known whether pragmatic language problems are related to specific types of behavioural problems., Aims: This study aims to clarify the incidence and nature of behavioural problems in children with PLI using a prognostic design in mainstream education. This design should provide valuable insights into the general relationship between PLI and various behavioural problems., Methods & Procedures: Teachers completed the Children's Communication Checklist (CCC) and the Strengths and Difficulties Questionnaire (SDQ) and provided additional data for a sample of 1364 children aged 4 years., Outcomes & Results: Within the community sample, pragmatic competence is highly correlated with behavioural problems. Pragmatic competence is a good predictor of behavioural problems, and once pragmatic competence is accounted for, structural language abilities do not predict behavioural problems. Children with pragmatic language impairment often show behavioural problems, largely of an externalizing nature. The most prominent problems are hyperactivity and the lack of prosocial behaviour, which reach clinical levels for this group. However, all problem levels are elevated compared with normally developing children., Conclusions & Implications: Young children with PLI show a wide variety of behavioural problems. Early assessment of pragmatic competence may benefit early detection of children at risk of behavioural problems. Furthermore, due to the relationship between pragmatic competence, behavioural problems and possible underlying disorders such as autism and attention-deficit hyperactivity disorder (ADHD), early assessment of pragmatic competence may also provide an early marker for the detection of autism or ADHD., (2010 Royal College of Speech & Language Therapists.)

Background: The increasing prevalence of specific language impairment (SLI) is a matter of current debate., Aims: Speech and language therapists and other authorities in Finland have discussed the prevalence of SLI since the 1990s. This discussion has been based on international studies because of the lack of national studies. This paper presents the first Finnish prevalence study of SLI in primary healthcare and, thus, participates in the international discussion on the prevalence of SLI. Furthermore, two samples of delayed language development (DLD) were studied., Methods & Procedures: This is a retrospective study from 1989-1999. It was conducted on the population of one of the biggest towns in Finland, and was collected from the statistical records of speech and language therapists., Outcomes & Results: The prevalence of SLI increased, and this increase was statistically significant. The prevalence of SLI was less than 1% in age group 0-6 years and, thus, presents a much lower prevalence than international discussion has suggested. SLI seems to be present particularly in boys though it was also increasing in girls. Furthermore, children with SLI seem to be more affected by receptive difficulties over the period studied. Particularly important is the observation that the prevalence of DLD was also increasing, and together with SLI they suggest a prevalence rate of 2.5% in Finland., Conclusions: The low prevalence of SLI in this study might be a consequence of the path of intervention that effectively separates SLI from delayed language development. Furthermore, the questions of language specific features needs to be emphasized. The findings of this study suggest that the prevalence of SLI increased as did the prevalence of DLD. The range of prevalence estimates of SLI in different studies raises the need for national and international epidemiological studies of SLI with equal criteria of assessment in each language.

Links have long been made between literacy and economic development, and recent governments in the UK have put great emphasis on the teaching of literacy to raise educational standards. There is substantial evidence to show that spoken and written language share some processes in common and that the development of literacy is supported by the development of spoken language. Anecdotal evidence from early years practitioners suggests that many children coming into early years education, particularly those from disadvantaged socioeconomic backgrounds, may not have the spoken language skills needed to develop reading and writing. This preliminary study aimed to investigate the extent to which the spoken language skills of children reared in poverty are depressed in comparison with the general population, and in comparison with their general cognitive abilities. Two tests were administered to children in their first term at nursery school to measure their spoken language skills and cognitive abilities: CELF-PUK and BAS II. More than half of the children were found to be language-delayed, although girls' receptive language abilities were significantly better than those of boys. Participants' language skills were also significantly depressed in comparison with their cognitive abilities. Government initiatives to raise awareness of spoken language in the early years are discussed, and implications for the future role of speech and language therapists working in the pre-school sector are considered.

The prevalence and the natural history of primary speech and language delays were two of four domains covered in a systematic review of the literature related to screening for speech and language delay carried out for the NHS in the UK. The structure and process of the full literature review is introduced and criteria for inclusion in the two domains are specified. The resulting data set gave 16 prevalence estimates generated from 21 publications and 12 natural history studies generated from 18 publications. Results are summarized for six subdivisions of primary speech and language delays: (1) speech and/or language, (2) language only, (3) speech only, (4) expression with comprehension, (5) expression only and (6) comprehension only. Combination of the data suggests that both concurrent and predictive case definition can be problematic. Prediction improves if language is taken independently of speech and if expressive and receptive language are taken together. The results are discussed in terms of the need to develop a model of prevalence based on risk of subsequent difficulties.