Social, emotional and behavioural difficulties associated with persistent speech disorder in children: A prospective population study.

Purpose: Social, emotional and behavioural difficulties (SEBD) in childhood are associated with negative consequences across the life course. Children with developmental language disorder have been identified as being at risk of developing SEBD but it is unclear whether a similar risk exists for children with speech sound disorder, a condition which impacts on children's ability to make themselves understood and has been shown to be associated with poor educational outcomes. Methods: Participants were children who attended the 8-year-old clinic in the Avon Longitudinal Study of Parents and Children (N = 7390). Children with speech sound disorder that had persisted beyond the period of typical speech acquisition (persistent speech disorder [PSD]) at age 8 were identified from recordings and transcriptions of speech samples (N = 263). Parent-, teacher- and child-reported questionnaires and interviews including the Strengths and Difficulties Questionnaire, Short Moods and Feelings Questionnaire and measures for antisocial and risk-taking behaviour were used to provide outcome scores for SEBD at 10-14 years in a series of regression analyses. Results: Following adjustment for biological sex, socio-economic status and Intelligence Quotient, children with PSD at age 8 were more likely to show peer problems at age 10-11 years compared with their peers, as reported by teachers and parents. Teachers were more likely to report problems with emotionality. Children with PSD were no more likely to report symptoms of depression than their peers. No associations were observed between PSD, risk of antisocial behaviour, trying alcohol at age 10 or smoking cigarettes at age 14. Conclusions: Children with PSD may be at risk in terms of their peer relationships. This could impact on their wellbeing and, while not observed at this age, may lead to depressive symptoms in older childhood and adolescence. There is also the potential that these symptoms may impact on educational outcomes.

Perspectives of preschool children in England with speech and language needs in the development of evidence-based activities.

BACKGROUND: The existing evidence is limited in terms of perspectives of preschool children with speech and language needs and their views on activities used to support their needs. This paper discusses a stream of work from the interdisciplinary research programme known as "Child Talk," based in England, UK. The overall purpose of this work stream was to gain the perspectives of preschool children aged 2 to 5 years and 11 months, with speech and language needs, to use in the development of an evidence-based framework of activities. METHODS: Twenty-four preschool children with a variety of needs from diverse backgrounds took part. An observational methodology was used to capture children's experiences. Children were filmed during a series of sessions, with innovative head-mounted cameras worn by the children and supported by researcher field notes. Framework analysis was used to analyse the data based on the body movement, vocalization, and visual attention of the children during these sessions. RESULTS AND CONCLUSIONS: Results included that children expressed enjoyment and engagement in the activities. The children expressed themselves and demonstrated their focus "multimodally" through combinations of body language, vocalization, and visual attention. These modalities were present across all contexts and children. It highlights the importance of encouraging participation in preschool children and consequently this innovative piece of work has national and international importance.

The role of pragmatics in mediating the relationship between social disadvantage and adolescent behavior.

OBJECTIVE: The relationship between social disadvantage, behavior, and communication in childhood is well established. Less is known about how these 3 interact across childhood and specifically whether pragmatic language skills act as a mediator between early social disadvantage and adolescent behavior. METHOD: The sample was the Avon Longitudinal Study of Parents and Children, a representative birth cohort initially recruited in England in 1991/1992 and followed through to adolescence and beyond. Of the original 13,992 live births, data were available for 2926 children at 13 years. Univariable analysis was first used to identify sociodemographic and other predictors of the Strengths and Difficulties Questionnaire (SDQ) at 13 years. The mediational role of the pragmatics scale of the Children's Communication Checklist (CCC) at 9 years was then tested, controlling for age, gender, and IQ. RESULTS: There was evidence of both a direct effect from social disadvantage (path C') to SDQ Total Behavior Score at 13 years (-.205; p < .001) and an indirect effect from social disadvantage to SDQ Total (-.225; p < .001) after adjusting for the CCC pragmatics scale as a mediator. The latter represents a reduction in the magnitude of the unadjusted effect or "total effect" (-.430), demonstrating that the pragmatics scale partially mediates the relationship of early social disadvantage and adolescent behavior (even after controlling for other covariates). The same relationship held for all but the pro-social subscale of the SDQ. CONCLUSION: The results provide evidence to suggest that there maybe a causal relationship between these variables, suggesting that interventions targeting pragmatic skills have the potential to reduce adolescent behavioral symptoms.

Integrating external evidence of intervention effectiveness with both practice and the parent perspective: development of 'What Works' for speech, language, and communication needs.

AIM: The aim of the study was to develop an ecologically valid synthesis of the evidence underpinning interventions for children with speech, language, and communication needs (SLCN), integrating a range of different data sources. METHOD: Three sources of information were integrated: the Cochrane Review of interventions for children with primary speech and language delays/disorder; current practice from an online survey of 534 speech and language therapists and other professionals working with children with SLCN; and parent reports of preferred outcomes. Evidence was ranked as strong, moderate, or indicative. RESULTS: Of the 58 interventions identified, three (5%) were found to have a strong level of evidence, 32 (56%) had moderate evidence, and 23 (39%) had indicative evidence. Five were universal interventions, the remainder targeted and universal. The integrated findings were then turned into an online interactive database, which is moderated and updated at regular intervals. INTERPRETATION: There are a number of interventions that have a moderate or strong level of evidence underpinning them but they tend not to be those used by practitioners who often favour well-established familiar programmes even if they have only indicative evidence. There is a degree of complementarity between professional and parent views about outcomes, albeit with different emphases.

The contribution of early language development to children's emotional and behavioural functioning at 6 years: an analysis of data from the Children in Focus sample from the ALSPAC birth cohort.

BACKGROUND: An association between children's early language development and their emotional and behavioural functioning is reported in the literature. The nature of the association remains unclear and it has not been established if such an association is found in a population-based cohort in addition to clinical populations. METHODS: This study examines the reported association between language development and emotional and behavioural functioning in a population-based cohort. Data from 1,314 children in the Children in Focus (CiF) sample from the Avon Longitudinal Study of Parents and Children (ALSPAC) were analysed. Regression models identified the extent to which early language ability at 2 years of age and later language ability at 4 years of age is associated with emotional and behavioural functioning at 6 years while accounting for biological and social risk and adjusting for age and performance intelligence (PIQ). RESULTS: A series of univariable and multivariable analyses identified a strong influence of biological risk, social risk and early and later language ability to emotional and behavioural functioning. Interestingly, social risk dropped out of the multivariate analyses when age and PIQ were controlled for. Early expressive vocabulary at 2 years and receptive language at 4 years made a strong contribution to emotional and behavioural functioning at 6 years in addition to biological risk. The final model accounted for 11.6% of the variance in emotional and behavioural functioning at 6 years. CONCLUSIONS: The study identified that early language ability at 2 years, specifically expressive vocabulary and later receptive language at 4 years both made a moderate, but important contribution to emotional and behavioural functioning at 6 years of age. Although children's language development is important in understanding children's emotional and behavioural functioning, the study shows that it is one of many developmental factors involved.

Common variation near ROBO2 is associated with expressive vocabulary in infancy.

Twin studies suggest that expressive vocabulary at ~24 months is modestly heritable. However, the genes influencing this early linguistic phenotype are unknown. Here we conduct a genome-wide screen and follow-up study of expressive vocabulary in toddlers of European descent from up to four studies of the EArly Genetics and Lifecourse Epidemiology consortium, analysing an early (15-18 months, 'one-word stage', N(Total) = 8,889) and a later (24-30 months, 'two-word stage', N(Total)=10,819) phase of language acquisition. For the early phase, one single-nucleotide polymorphism (rs7642482) at 3p12.3 near ROBO2, encoding a conserved axon-binding receptor, reaches the genome-wide significance level (P=1.3 × 10(-8)) in the combined sample. This association links language-related common genetic variation in the general population to a potential autism susceptibility locus and a linkage region for dyslexia, speech-sound disorder and reading. The contribution of common genetic influences is, although modest, supported by genome-wide complex trait analysis (meta-GCTA h(2)(15-18-months) = 0.13, meta-GCTA h(2)(24-30-months) = 0.14) and in concordance with additional twin analysis (5,733 pairs of European descent, h(2)(24-months) = 0.20).

Application of systematic reviews in speech-and-language therapy.

BACKGROUND: Systematic reviews are increasingly being carried out in speech-and-language therapy and are used by practitioners, service commissioners, policy-makers and researchers to inform decision-making, as the body of evidence available about speech-and-language therapy grows. Although systematic reviewing is developing to incorporate new methods of review and synthesis, there are currently limitations in the use of some types of systematic reviews within speech-and-language therapy. AIMS: The purpose of this paper is to provide an overview of the steps involved in the systematic review process and the range of options available. It highlights some challenges to using this process in speech-and-language therapy, with examples based in part on the authors' experiences of involvement in two systematic reviews. A number of developments in systematic review methodology will be outlined and several new approaches to reviewing, both within and outside of speech-and-language therapy, are introduced. These include realist synthesis, evidence-based practice briefs, speech BITE™ and the journal Evidence-Based Communication Assessment and Intervention. MAIN CONTRIBUTION: This paper highlights some of the current benefits and limitations of systematic reviews in speech-and-language therapy. It will facilitate readers to use and carry out systematic reviews in the speech-and-language therapy field. CONCLUSIONS: Systematic reviews are useful in speech-and-language therapy, but awareness of their limitations is important to practitioners, commissioners, policy-makers and researchers. New developments may further increase the benefits of systematic reviews.