Educational transitions of 7-year-old children with SLI in language units: a longitudinal study

Academic achievement and productivity losses associated with speech, language and communication needs

BACKGROUND

Childhood speech, language and communication needs (SLCN) impose a significant burden on individuals, families and society. There are explicit costs related to increased health utilization and expenditure. Additionally, there may be indirect costs associated with a child's employment prospects in the long term because of the child's low literacy and numeracy, which in turn affects adult labour force participation (LFP). Several reviews have identified that there is paucity of published evidence on the costs of SLCN. Motivated by broad policy implications, and the lack of prior research in this area, this paper calculates the indirect costs and workplace productivity losses of children with SLCN.

AIMS

To estimate the indirect costs of SLCN associated with a child's reduced long-term productivity.

METHODS & PROCEDURES

Using 12 years of data from a longitudinal study of Australian children, we employed a panel fixed-effects model to estimate academic achievement at 14-15 years of age. Using these estimates, we employed a human capital approach (HCA) to estimate the projected LFP for children with SLCN, measured by workforce participation and foregone wages. LFP is estimated by extrapolating a child's academic achievement at 14-15 years of age to adulthood outcomes.

OUTCOMES & RESULTS

The results showed that a 1 SD (standard deviation) decrease in SLCN is equivalent to 0.19 (95% confidence interval (CI) = 0.09, 0.30) SD decrease in academic achievement at 14-15 years, 0.79% (95% CI = 0.37, 1.21) decrease in work participation and A$453 (95% CI = A$207, A$674) per annum in lost wages. The average work participation penalty across all level of SLCN (-3, -2, -1) is A$628 (95% CI = A$236, A$894) per person per year. Based on the prevalence of 8.3% from our sample, this equates to lifetime costs of A$21.677 billion (US$14.28 billion, €13.08 billion, £11.66 billion) for children with SLCN in Australia. Speech pathology treatment appears to have a positive impact on work participation and wages. On average A$355 (95% CI = A$346, A$355) per person per year could be saved through treatment or identification (the difference in lost wages for children with and without speech pathology treatment at each SLCN level (-1, -2 ,-3) calculated as a weighted average). This equates to lifetime savings of A$5.22 billion (US$3.44 billion, €3.15 billion, £2.81 billion) for children with SLCN in Australia.

CONCLUSIONS & IMPLICATIONS

Overall, the findings showed that SLCN are associated with increased indirect costs through reduced workforce participation. The evidence from this study can be used to inform policies on the societal costs of SLCN. What this paper adds What is already known on this subject Childhood SLCN impose significant burden on individuals, families and society. There are explicit costs related to increased health utilization and expenditure. Additionally, there may be indirect costs associated with a child's employment prospects in the long term because of the child's low literacy and numeracy, which in turn affects adult LFP. Several reviews have identified that there is paucity of published evidence on the costs of SLCN. Motivated by broad policy implications, and the lack of prior research in this area, this paper calculates the indirect costs and workplace productivity losses of children with SLCN. What this paper adds to existing knowledge This study estimates the academic achievement and indirect costs of SLCN associated with a child's reduced long-term productivity. Using 12 years of data from a longitudinal study of Australian children, we employed a panel fixed-effects model to estimate academic achievement at 14-15 years of age. Using these estimates, we used a human capital approach to estimate the projected LFP for children with SLCN, measured by workforce participation and foregone wages. LFP is estimated by extrapolating a child's academic achievement at 14-15 years of age to adulthood outcomes. What are the potential or actual clinical implications of this work? SLCN are associated with increased indirect costs through reduced workforce participation. The evidence from this study provides one of the first indirect cost estimates of how SLCN impacts LFP through educational achievement. Early identification, intervention and screening for SLCN may be useful offsets to reduce the economic effects identified here.

Financial capability and functional financial literacy in young adults with developmental language disorder

BACKGROUND

Financial capability is an essential feature of the organisation of one's personal life and engagement with society. Very little is known of how adequately individuals with developmental language disorder handle financial matters. It is known that language difficulties place them at a disadvantage in many aspects of their development and during their transition into adulthood, leading to the possibility that financial issues may prove burdensome for them. This study examines the financial capability and functional financial literacy of young adults with developmental language disorder and compares them to those of age matched peers. We tested the expectation that those with developmental language disorder would find financial management more challenging than would their peers, and that they would need to seek greater support from family members or other people.

METHODS

Participants completed a detailed individual interview, which included items drawn from the British Household Panel Survey and additional measures of financial capability, functional financial literacy and of perceived support. Nonverbal IQ, language, reading and numeracy measures were also collected.

RESULTS

Compared to typically developing age matched peers, young people with developmental language disorder report less extensive engagement with financial products and lower competence in functional financial literacy. A considerably higher proportion of those with developmental language disorder (48% vs. 16% of age matched peers) report that they draw on support, primarily from parents, in various financial tasks, including paying bills, choosing financial products, and taking loans from family or friends.

CONCLUSIONS

This is the first study to consider the financial capability skills and functional financial literacy of young adults with developmental language disorder. We provide novel evidence that some young adults with developmental language disorder lack functional financial skills and require support to successfully manage their finances. This has policy implications that relate not only to engaging affected individuals in discussions about financial management but also to wider familial support.

Pragmatic Language Impairment without Autism

The ‘borderlands’ of autism are of particular interest to researchers and clinicians as we learn more about pervasive disorders and how to manage them. One group of children who have caused particular controversy are those referred to as having semantic-pragmatic disorder or pragmatic language impairment. The present article examines the profiles of 10 children (selected from a wider project on language impairment) who are definitely considered to have pragmatic impairments by their teachers, their speech and language therapists and the researchers and on the basis of scores from the Children’s Communication Checklist (CCC). These children are compared with each other and with children with more typical specific language impairments (SLIs) in the wider study. The 10 children’s characteristics are also examined in terms of classification and whether some might be better described using existing autistic spectrum disorder terminology. Children with pragmatic language impairment were all found to have developed first words earlier than the SLI group, but were more impaired than their peers in the areas of stereotyped language, rapport and context. Social communication skills as measured by the CCC did not seem more impaired than in other children with SLI, but on the Harter scale peer interactions were rated as significantly poorer. A preliminary comparison with autistic symptomatology suggested that four of the 10 did have difficulties in this area and might be better described as having autism or Asperger’s disorder.

Enablers and challenges of post-16 education and employment outcomes: the perspectives of young adults with a history of SLI

BACKGROUND

Research studies have begun to investigate the post-16 outcomes for young adults with a specific language impairment (SLI). As yet only tentative conclusions can be drawn with respect to academic and employment outcomes and the factors that are associated with more positive outcomes. Evidence for these findings has relied predominantly on associations between various language, academic and psychosocial assessments. Little attention has been paid to the perspective of the young person.

AIMS

To investigate from the perspective of a group of young people with a history of SLI the factors they believed have enabled and presented a challenge to their post-16 education and employment outcomes and experiences.

METHODS & PROCEDURES

Nineteen (four female, 15 male) young people aged from 19 to 23 years (average age 21 years), who had all attended the same residential special school for pupils with SLI, were interviewed face to face to explore their views as to what had enabled and limited their transition experiences to date. The data were analysed using thematic analysis.

OUTCOMES & RESULTS

The majority of the young people saw themselves as key agents of change and very active participants in steering their own transition since leaving school. They acknowledged the important role played by their parents and families and how factors such as SLI had affected their transition experiences.

CONCLUSIONS & IMPLICATIONS

The study supports evidence from research with different groups of young people with special educational needs (SEN) and disabilities of the importance of school and post-16 curriculums which develop agency on behalf of the young person.

The Social Communication Intervention Project: a randomized controlled trial of the effectiveness of speech and language therapy for school-age children who have pragmatic and social communication problems with or without autism spectrum disorder

BACKGROUND

Children who show disproportionate difficulty with the pragmatic as compared with the structural aspects of language are described as having pragmatic language impairment (PLI) or social communication disorder (SCD). Some children who have PLI also show mild social impairments associated with high-functioning autism or autism spectrum disorder (ASD). There is little robust evidence of effectiveness of speech-language interventions which target the language, pragmatic or social communication needs of these children.

AIMS

To evaluate the effectiveness of an intensive manualized social communication intervention (SCIP) for children who have PLI with or without features of ASD.

METHODS & PROCEDURES

In a single-blind RCT design, 88 children with pragmatic and social communication needs aged 5;11-10;8, recruited from UK speech and language therapy services, were randomly assigned in a 2:1 ratio to SCIP or to treatment-as-usual. Children in the SCIP condition received up to 20 sessions of direct intervention from a specialist research speech and language therapist working with supervised assistants. All therapy content and methodology was derived from an intervention manual. A primary outcome measure of structural language and secondary outcome measures of narrative, parent-reported pragmatic functioning and social communication, blind-rated perceptions of conversational competence and teacher-reported ratings of classroom learning skills were taken pre-intervention, immediately post-intervention and at 6-month follow-up. Analysis was by intention to treat.

OUTCOMES & RESULTS

No significant treatment effect was found for the primary outcome measure of structural language ability or for a measure of narrative ability. Significant treatment effects were found for blind-rated perceptions of conversational competence, for parent-reported measures of pragmatic functioning and social communication, and for teacher-reported ratings of classroom learning skills.

CONCLUSIONS & IMPLICATIONS

There is some evidence of an intervention effect on blind and parent/teacher-reported communication outcomes, but not standardized language assessment outcomes, for 6-11-year-old children who have pragmatic and social communication needs. These findings are discussed in the context of the increasingly central role of service user outcomes in providing evidence for an intervention. The substantial overlap between the presence of PLI and ASD (75%) across the whole cohort suggests that the intervention may also be applicable to some verbally able children with ASD who have pragmatic communication needs.

Effects of computer-based intervention through acoustically modified speech (Fast ForWord) in severe mixed receptive-expressive language impairment: outcomes from a randomized controlled trial

Seventy-seven children between the ages of 6 and 10 years, with severe mixed receptive-expressive specific language impairment (SLI), participated in a randomized controlled trial (RCT) of Fast ForWord (FFW; Scientific Learning Corporation, 1997, 2001). FFW is a computer-based intervention for treating SLI using acoustically enhanced speech stimuli. These stimuli are modified to exaggerate their time and intensity properties as part of an adaptive training process. All children who participated in the RCT maintained their regular speech and language therapy and school regime throughout the trial. Standardized measures of receptive and expressive language were used to assess performance at baseline and to measure outcome from treatment at 9 weeks and 6 months. Children were allocated to 1 of 3 groups. Group A (n = 23) received the FFW intervention as a home-based therapy for 6 weeks. Group B (n = 27) received commercially available computer-based activities designed to promote language as a control for computer games exposure. Group C (n = 27) received no additional study intervention. Each group made significant gains in language scores, but there was no additional effect for either computer intervention. Thus, the findings from this RCT do not support the efficacy of FFW as an intervention for children with severe mixed receptive-expressive SLI.

The nature of written language deficits in children with SLI

Children with specific language impairment (SLI) have associated difficulties in reading decoding and reading comprehension. To date, few research studies have examined the children's written language. The aim of the present study was to (a) evaluate the nature and extent of the children's difficulties with writing and (b) investigate the relationship between oral and written language. Eleven children with SLI were identified (mean age = 11 years) and were compared with a group of children matched for chronological age (CA; mean age = 11;2 [years;months]) and language age (LA; mean CA = 7;3). All groups completed standardized measures of language production, writing, and reading decoding. The writing assessment revealed that the SLI group wrote fewer words and produced proportionately more syntax errors than the CA group, but they did not differ on a measure of content of written language or on the proportion of spelling errors. The SLI group also produced proportionately more syntax errors than the LA group. The relationships among oral language, reading, and writing differed for the 3 groups. The nature and extent of the children's written language problems are considered in the context of difficulties with spoken language.