A newsletter dedicated to speech & language in school-age children

Social-Emotional Outcomes for

Children With SLI IN THIS IS S UE
Mok, P. L. H., Pickles, A., Durkin, K., & Conti-Ramsden, G.
REVIEWS
(2014). Longitudinal trajectories of peer relations in children with
specific language impairment. Journal of Child Psychology and
Psychiatry, 55, 516–527 Social-Emotional Outcomes
Summarized by Carol Westby for Children With SLI
page 1
Specific language impairment (SLI) is not so specific. SLI
R E V I E W significantly affects academic attainments and vocational
options (Conti-Ramsden, Durkin, Simkin, & Knox, 2009). SLI
Empathy in Students Who Are
Deaf or Hard of Hearing
puts students at risk not only for academic difficulties but also page 5
for social-emotional difficulties. Difficulties in expression and/
or comprehension of language make participation in conversation Pragmatic Knowledge Versus
challenging. As a consequence, children with SLI engage less in active Pragmatic Use
interactions than do those with typical language, enter less frequently into page 8
positive social interactions, are less sensitive to the initiations offered by
others, and manifest situationally inappropriate verbal responses (e.g., RESOURCE REVIEW
Fujiki, Brinton, Isaacson, & Summers, 2001; McCormack, Harrison,
McLeod, & McAllister, 2011). Experiencing difficulties with peer Observational Pragmatics Scales
relations during childhood means that many children with SLI enter page 12
adolescence less equipped in the skills needed for this area of life.
Numerous studies have shown the link between early SLI and I D E A S WA P
literacy skills. Consequently, speech-language pathologists (SLP)
incorporate reading and writing activities in their language intervention. Assessing Personal Event
Less attention has been given to the social-emotional implications of Narratives
SLI and the roles that SLPs might play in this area. In a recent study, page 13
Conti-Ramsden and colleagues investigated the developmental
trajectories of behavioral, emotional, and social difficulties in individuals
with a history of SLI from childhood to adolescence (St. Clair, Pickles,
Durkin, & Conti-Ramsden, 2011). They observed an increase in peer
problems and in the proportion of individuals functioning in the
impaired range from childhood to adolescence. By 16 years of age,
against national norms, nearly 40% of adolescents with SLI appeared
impaired in their interactions with peers.
SLI is a very heterogeneous disorder. In general, children with SLI
are sociable (Wadman, Durkin, & Conti-Ramsden, 2008), but there is
evidence that they are more likely to be withdrawn (Brinton & Fujiki,
2002) and less likely to exhibit skilled social behaviors (Fujiki, Brinton,

Volume 28 • Issue 4 http://wom.sagepub.com March/April 2017

 Word of Mouth 28:4 March/April 2017

Morgan, & Hart, 1999). The authors of this study
sought to identify the developmental patterns that lead
to specific outcomes. They examined factors that have
the potential to influence developmental trajectories of
children with SLI, including expressive, receptive, and
expressive language skills, as well as emotional
symptoms, conduct problems, hyperactivity, and
prosocial behavior.
Participants
Participants had a history of SLI and were originally
part of a wider study: the Manchester Language Study
(Conti-Ramsden & Botting, 1999; Conti-Ramsden,
Crutchley, & Botting, 1997).
The initial cohort of 242 children (6;6 to 7;9 years)
was a random sample of 50% of all 7-year-olds
attending 118 language units across England. Children
were excluded from the study if they were reported by
their teachers as having frank neurological difficulties,
hearing impairment, a diagnosis of autism, or a general
learning disability. Participants were contacted again at
ages 8, 11, 14, and 16. The average standard scores for
receptive language at both ages and for expressive
language at age 7 years were around 1 SD below the
population mean, while average expressive language
score at age 11 years was close to 2 SD below.
Participants were classified into four groups based on
their concurrent language and Performance Intelligence
Quotient (PIQ) scores:
•• SLI-PIQ standard score 85 or above (i.e., in the
normal range) and concurrent receptive or expressive
language standard scores below 85.
•• Non-specific language impaired–PIQ standard
scores below 85 and receptive or expressive language
standard scores below 85.
•• Low cognition, resolved language–PIQ standard
scores below 85 and receptive and expressive
language standard scores 85 or above.
•• Resolved language–PIQ, receptive and expressive
language standard scores all 85 or above.
The majority, 70.5%, of the children had impaired
language ability at age 7. There was little change in the
language status at age 8. At ages 11 and 16, the
percentages of children with SLI fell to 39.6% and
36.1%, respectively, while the percentages with non-
specific language impairment rose to 43.8% and 48.9%,
respectively. The changing SLI profiles of some of the
participants were thus due to their PIQ scores having
fallen since they were recruited to the study. There is
evidence suggesting that children with low PIQ and
language skills perform in important ways much like
children with a history of SLI who have PIQ within the
normal range (Leonard, 2003). At ages 11 and 16,
around 85% of the children showed language ability in

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Services
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2
 Word of Mouth 28:4 March/April 2017
the impaired range. None of the children in the original
cohort had a diagnosis of autism.
Measures
Peer Relations
Two measures were used to assess peer relations: the
peer problem subscale of the teacher-report version of
the Strengths and Difficulties Questionnaire (SDQ;
Goodman, 1997), and teachers’ responses to three
items in the Rutter Children’s Behaviour Questionnaire
(Rutter, 1967). The peer problem subscale of the SDQ
was administered at ages 11 and 16. Items of the peer
problem subscale include Rather solitary, tends to play
alone, Has at least one good friend, Generally liked by
other children, Picked on or bullied by other children,
and Gets on better with adults than with other children.
The Rutter Children’s Behaviour Questionnaire was
completed by the participants’ teachers at ages 7, 8, and
11 years. This consists of 26 statements, and the teacher
is asked to score each item as doesn’t apply, applies
somewhat, or certainly applies. Scores derived from
the Rutter questionnaire and from the SDQ have been
found to be highly correlated and have equivalent
predictive validity (Goodman, 1997).
Prosocial Behaviour and Behavioral Difficulties
The SDQ behavioral measures (teacher-reported
version; Goodman, 1997): prosocial behavior, emotional
symptoms, conduct problems, and hyperactivity were
obtained at age 11 years. The prosocial subscale consists
of five positive items: considerate of other people’s
feelings, shares readily with other children, helpful if
someone is hurt, upset or feeling ill, kind to younger
children, and often volunteers to help others. Examples
of items constituting three other behavioral difficulty
subscales include: Many worries, often seems worried
(emotional symptoms); Often has temper tantrums or hot
tempers (conduct problems); Constantly fidgeting or
squirming (hyperactivity). Thresholds for identifying
normal, borderline, and abnormal behavior are available
for the subscales.
Performance IQ (PIQ)
Raven’s Coloured Progressive Matrices was used to
assess participants’ PIQ at age 7 (Raven, 1986). At age
11, Block Design and Picture Completion of the U.K.
version of the Wechsler Intelligence Scale for Children–
Third Edition (Wechsler, 1992) was administered.
Receptive and Expressive Language
At ages 7and 11, receptive language was assessed
using the Test for Reception of Grammar (Bishop,
1982). Expressive language at age 7 was assessed using
the Bus Story Test (Renfrew, 1991), and at age 11, it
was measured by the Recalling Sentences subtest of the
Clinical Evaluation of Language Fundamentals–
Revised (Semel, Wiig, & Secord, 1987).
Reading Accuracy and Comprehension
The Word Reading subtest of the British Abilities
Scale (Elliot, 1983) was used to assess reading accuracy
at age 7. At age 11, the Basic Reading and the Reading
Comprehension subtests of the Wechsler Objective
Reading Dimensions (Wechsler, 1993) were used to
measure reading accuracy and reading comprehension,
respectively.
Pragmatic Language
Of the 171 children in this study, 54 (31.6%) were
considered to have semantic/pragmatic difficulties at
age 7. Pragmatic language skills were formally assessed
at age 11 using the Children’s Communication Checklist
(CCC; Bishop, 1998). The checklist has been shown to
differentiate between children with pragmatic language
impairment and those with more typical SLI.
Results
•• Peer problems increased significantly between 7 and
11, and continued to increase beyond 11, but not
significantly.
•• A four-group model best fit the data: low-level/no
problems in peer relations (22.2%), childhood-
limited problems (12.3%), childhood-onset persistent
problems (39.2%), and adolescent-onset problems
(26.3%).
•• The group with low/no problems exhibited few
problems from childhood to adolescence. For the
group with childhood-limited problems, by age 16,
the SDQ mean peer problem score had fallen, and
none of these children were classified as having
borderline or abnormal levels of difficulties. The
childhood-onset persistent problems group showed
an increase in the Rutter mean scores between ages
3
 Word of Mouth 28:4 March/April 2017
7 and 11. Overall, 74.1% of children in this group at
age 11 and 62.2% at age 16 were classified as having
borderline or abnormal levels of peer problems. For
the group with adolescent-onset problems, the
percentages scoring above the SDQ threshold for
borderline or abnormal levels of peer problems
increased from 10% to 40.6% during this period.
•• Five predictors for group membership were measures
of pragmatic language skills at age 11, prosocial
behavior, hyperactivity levels, and levels of
emotional and conduct disorders.
•• For children with persistent peer problems, the odds
of being rated by their teachers as having pragmatic
language difficulties was 2.5 times higher than for
children with low/no problems.
Discussion
Somewhat surprising was the finding that there was not
a significant relationship between expressive and receptive
language abilities and the different trajectories. The
authors suggest that this was because the language
assessments tapped only some structural language skills
and not higher order skills such as making inferences and
organizing discourse or texts. This finding could be
viewed as a caution for SLPs. The majority of popular
assessments for SLI focus on structural aspects of language
development. As students get older, they may master these
skills, but continue to have difficulty with the language
demands in social and academic settings. Scores on these
formal tests may be used, inappropriately, to justify
discharging them from services. The findings offer positive
messages regarding peer relations without problems for
some children and of amelioration of difficulties across
time in others. The groups with low/no problems or with
childhood-limited difficulties comprised approximately
one third of the sample. In contrast, children who had
persistent, or adolescent-onset, difficulties in peer relations
from childhood to adolescence represented two thirds of
children with a history of SLI.
Differences in peer relations were observed from
early childhood (7 years) and were evident in
adolescence, with trajectories diverging more widely as
children entered middle childhood.
Based on these findings, the authors suggest that the
identification of pragmatic difficulties and emotional
problems could be critical to the amelioration of potential
difficulties in peer relations. The use of teacher report of
4
pragmatic difficulties was informative at age 7 as was
the CCC and the SDQ emotional scale in middle
childhood, at age 11. Results of randomized controlled
trials show that pragmatic difficulties (Adams et al.,
2012) and emotional problems (Sanders, Baker, &
Turner, 2012) can be addressed effectively, in at least
some children. The authors conclude that clinically, it is
advisable not only to identify deficits but to evaluate
the extent to which potential protective and/or positive
factors are present. The SDQ prosocial scale in middle
childhood was found to be a particularly strong predictor
of differences in the trajectories of peer relations of
children with a history of SLI.
Just as SLPs now typically consider literacy skills when
working with students with SLI, they should also consider
the early signs of social difficulties and incorporate goals
in these areas on students’ individualized educational
plans.
References
Adams, C., Lockton, E., Freed, J., Gaile, J., Earl, G., McBean,
K., . . . Law, J. (2012). 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 communicative
problems with or without autism spectrum disorders.
International Journal of Language and Communication
Disorders, 47, 233–244.
Bishop, D.V.M. (1982). Test for reception of grammar.
Manchester, England: Author.
Bishop, D. V. M. (1998). Development of the Children’s
Communication Checklist (CCC): A method for assessing
qualitative aspects of communicative impairment in children.
Journal of Child Psychology and Psychiatry, 39, 879–893.
Brinton, B., & Fujiki, M. (2002). Social development in children
with specific language impairment and profound hearing
loss. In P. K. Smith & C. H. Hart (Eds.), Blackwell handbook
of childhood social development (pp. 588–603). Malden,
MA: Blackwell.
Conti-Ramsden, G., & Botting, N. (1999). Characteristics of
children attending language units in England: A national
study of 7-year-olds. International Journal of Language &
Communication Disorders, 34, 359–366.
Conti-Ramsden, G., Crutchley, A., & Botting, N. (1997). The
extent to which psychometric tests differentiate subgroups of
children with specific language impairment. Journal of
Speech, Language, and Hearing Research, 40, 765–777.
Conti-Ramsden, G., Durkin, K., Simkin, Z., & Knox, E. (2009).
Specific language impairment and school outcomes. I:
Identifying and explaining variability at the end of compulsory
education. International Journal of Language and
Communication Disorders, 44, 15–35.
 Word of Mouth 28:4 March/April 2017
Elliot, C. D. (1983). British Ability Scales. Windsor, UK:
NFER-Nelson.
Fujiki, M., Brinton, B., Isaacson, T., & Summers, C. (2001).
Social behaviors of children with language impairment on
the playground: A pilot study. Language, Speech, and
Hearing Services in Schools, 32, 101–113.
Fujiki, M., Brinton, B., Morgan, M., & Hart, C.H. (1999).
Withdrawn and sociable behavior of children with language
impairment. Language, Speech, and Hearing Services in
Schools, 30, 183–195.
Goodman, R. (1997). The Strengths and Difficulties
Questionnaire: A research note. Journal of Child Psychology
and Psychiatry, 38, 581–586.
Leonard, L. (2003). Specific language impairment:
Characterizing the deficit. In Y. Levy & J. Schaeffer (Eds.),
Towards a definition of SLI (pp. 209–231). Mahwah, NJ:
Lawrence Erlbaum.
McCormack, J., Harrison, L. J., McLeod, S., & McAllister, L.
(2011). A nationally representative study of the association
between communication impairment at 4–5 years and
children’s life activities at 7–9 years. Journal of Speech,
Language, and Hearing Research, 54, 1328–1348.
Raven, J. C. (1986). Coloured progressive matrices. London,
England: H. K. Lewis.
Renfrew, C. (1991). The bus story: A test of continuous speech.
Oxford, UK: Author.
Empathy in Students Who Are Deaf or Hard of Hearing
Netten, A. P., Rieffe, C., Theunissen, S. C. P. M., Soede, W., Dirks, E., Briaire, J. J., &
Frijns, J. H. M. (2015). Low empathy in deaf and hard of hearing (pre)adolescents compared
to normal hearing controls. PLoS ONE, 10(4), Article e0124102. doi:10.1371/journal
Summarized by Carol Westby
Empathy is defined as the ability to perceive and
understand another person’s emotional state and the
competence to appropriately respond to others’
emotions. It is needed to induce prosocial behavior and
is often referred to as the social glue in relationships.
Little is known about the development of empathy in
deaf and hard-of-hearing (DHH) children, but
prerequisites for empathy, such as emotion recognition
and regulation and development of a Theory of Mind
(ToM), have been shown to be delayed in DHH
children. Although, initially, children with cochlear
implants (CI) were found to perform as well as normal
hearing (NH) children, at an older age, they fell behind
on more advanced ToM abilities such as false belief
tasks (Bachara, Raphael, & Phelan, 1980; Ketelaar,
Rieffe, Wiefferink, & Frijns, 2012; Rieffe, 2012)
The purpose of this study was to determine the
differences in the levels of self-reported and observed
Rutter, M. (1967). A children’s behaviour questionnaire for
completion by teachers: Preliminary findings. Journal of
Child Psychology and Psychiatry, 8, 1–11.
Sanders, M. R., Baker, S., & Turner, K. M. (2012). A
randomized controlled trial evaluating the efficacy of
Triple P Online with parents of children with early-onset
conduct problems. Behaviour Research and Therapy, 50,
675–684.
Semel, E., Wiig, E., & Secord, W. (1987). Clinical evaluation of
language fundamentals–revised. San Antonio: Psychological
Corporation.
St. Clair, M.C., Pickles, A., Durkin, K., & Conti-Ramsden, G.
(2011). A longitudinal study of behavioral, emotional and
social difficulties in individuals with a history of specific
language impairment (SLI). Journal of Communication
Disorders, 44, 186–199.
Wadman, R., Durkin, K., & Conti-Ramsden, G. (2008). Self-
esteem, shyness, and sociability in adolescents with specific
language impairment (SLI). Journal of Speech, Language,
and Hearing Research, 51, 938–952.
Wechsler, D. (1992). Wechsler Intelligence Scale for children–
Third Edition–Revised, UK. Sidcup, UK: The Psychological
Corporation.
Wechsler, D. (1993). Wechsler objective reading dimensions.
London, England: The Psychological Corporation.
empathy between DHH and NH children. To identify
those factors that may be most influential for the levels
of empathy in DHH children, the researchers also
investigated the influence of several audiological
factors on empathic abilities, such as language
development, intelligence, degree of hearing loss, age
at intervention of hearing loss, type of device, mode of
communication, and educational setting.
The Study
Participants
The researchers recruited 122 DHH children and a
control group consisting of 162 NH children from the
Netherlands and the Dutch-speaking part of Belgium to
participate in this study. All children were between 9