Prevalence and functional impact of social (pragmatic) communication disorders.

BACKGROUND: The aim of this study was to evaluate the Children's Communication Checklist-2 (CCC-2) for measuring social-pragmatic communication deficits and to ascertain their prevalence and functional impact in a community sample. METHODS: We used parent and teacher responses to the CCC-2 to approximate inclusion (poor social-pragmatic skills) and exclusion (poor structural language skills or autistic symptomatology) criteria for social (pragmatic) communication disorder (SPCD). We tested the prevalence of social-pragmatic deficits in a population-based sample of children (n = 386) aged 5-6 years old using CCC-2 algorithms. We also investigated the academic and behavioural profiles of children with broadly defined limitations in social-pragmatic competence on the CCC-2. RESULTS: Regardless of the diagnostic algorithm used, the resulting prevalence rates for social-pragmatic deficits indicated that very few children had isolated social-communication difficulties (0-1.3%). However, a larger proportion of children (range: 6.1-10.5%) had social-pragmatic skills outside the expected range alongside structural language difficulties and/or autism spectrum symptoms, and this profile was associated with a range of adverse academic and behavioural outcomes. CONCLUSIONS: A considerable proportion of children in the early years of primary school has social-pragmatic deficits that interfere with behaviour and scholastic activity; however, these rarely occur in isolation. Exclusionary criteria that include structural language may lead to underidentification of individuals with social-pragmatic deficits that may benefit from tailored support and intervention.

Vocabulary interventions for second language (L2) learners up to six years of age.

BACKGROUND: Second language (L2) learners are a heterogeneous group. Their L2 skills are highly varied due to internal factors (e.g. cognitive development) and external factors (e.g. cultural and linguistic contexts). As a group, their L2 vocabulary skills appear to be lower than their monolingual peers. This pattern tends to persist over time and may have negative consequences for social interaction and inclusion, learning, and academic achievement. OBJECTIVES: To examine the immediate and long-term effects of second language (L2) vocabulary interventions targeting L2 learners up to six years of age on vocabulary and social-emotional well-being. To examine the associations between L2 vocabulary interventions and the general characteristics of L2 learners (e.g. age, L2 exposure, and L1 skills). SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was December 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing the effects of vocabulary interventions for L2 learners up to six years of age with standard care. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Our primary outcomes were 1. receptive and 2. expressive L2 vocabulary (both proximal and distal), and 3. mean length of utterance (MLU; which is a measure of potential adverse effects). Our secondary outcomes were 4. L2 narrative skills, 5. L1 receptive vocabulary (both proximal and distal), 6. L1 expressive vocabulary (both proximal and distal), 7. L1 listening comprehension, 8. L2 grammatical knowledge, 9. L2 reading comprehension (long-term), and 10. socio-emotional well-being (measured with Strengths and Difficulties Questionnaire). MAIN RESULTS: We found 12 studies involving 1943 participants. Two studies were conducted in Norway, seven in the USA, and single studies conducted in Canada, China, and the Netherlands. Ten studies were conducted in preschool settings, with a preschool teacher being the most common delivery agent for the intervention. The interventions were mainly organised as small-group sessions, with three or four children per group. The mean dosage per week was 80 minutes and ranged from 24 to 120 minutes. The studies commonly applied shared book reading (reading aloud with the children), with target words embedded in the books. Standard care differed based on the setting and local conditions in each country or (pre)school. In some studies, the comparison groups received vocabulary instruction in preschool groups. Compared to standard care, the effect of L2 vocabulary interventions varied across outcome measures. For vocabulary measures including words that were taught in the intervention (proximal outcome measures), the intervention effects were large for both receptive L2 vocabulary (i.e. understanding of words; standardised mean difference (SMD) 0.97, 95% confidence interval (CI) 0.64 to 1.30; 4 studies, 1973 participants; very low-certainty evidence) and expressive L2 vocabulary (i.e. expressing or producing words; SMD 0.86, 95% CI 0.56 to 1.17; 6 studies, 1121 participants; very low-certainty evidence). However, due to some concerns in the overall risk of bias assessment, substantial heterogeneity, and wide CIs, we have limited confidence in these results. For language measures that did not include taught vocabulary (distal outcome measures), the intervention effects were small for receptive vocabulary (SMD 0.29, 95% CI 0.02 to 0.55; 6 studies, 1074 participants; low-certainty evidence) and probably made little to no difference to expressive vocabulary (SMD 0.10, 95% CI -0.02 to 0.23; 7 studies, 960 participants; moderate-certainty evidence). There was little to no intervention effect on L2 listening comprehension (SMD 0.19, 95% CI -0.31 to 0.68; 2 studies, 294 participants; very low-certainty evidence), but the evidence was uncertain, and the interventions probably increased L2 narrative skills slightly (SMD 0.37, 95% CI 0.14 to 0.59; 2 studies, 487 participants; moderate-certainty evidence). Only one study reported data on MLU, and we were unable to examine the effect of intervention on this outcome. The level of certainty of the evidence was downgraded mainly due to inconsistency and imprecision. We were unable to draw conclusions about socio-emotional well-being, or conduct the planned subgroup analyses to examine the second objective, due to lack of data. AUTHORS' CONCLUSIONS: Findings from this review suggest that, compared to standard care, vocabulary interventions may benefit children's L2 vocabulary learning but have little to no effect on their listening comprehension, though the evidence is uncertain. Vocabulary interventions probably improve the children's storytelling skills slightly. Due to the limited number of studies that met our inclusion criteria and the very low- to moderate-certainty evidence as a result of inconsistency and imprecision, implications for practice should be considered with caution. This review highlights the need for more high-quality trials (e.g. RCTs) of vocabulary interventions for L2 learners, particularly studies of learners outside the USA.

Editorial Perspective: Speaking up for developmental language disorder - the top 10 priorities for research.

Developmental language disorder (DLD) is one of the most common neurodevelopmental conditions, yet is chronically underserved, with far fewer children receiving clinical services than expected from prevalence estimates, and very little research attention relative to other neurodevelopmental conditions of similar prevalence and severity. This editorial describes a research priority-setting exercise undertaken by the Royal College of Speech and Language Therapists, which aims to redress this imbalance. From consultations with researchers, practitioners and individuals with lived experience, 10 research priorities emerge. Our goal is to share these priorities with the wider research community, to raise awareness and encourage research collaboration to improve outcomes for young people with DLD.

Mutualistic coupling of vocabulary and non-verbal reasoning in children with and without language disorder.

Mutualism is a developmental theory that posits positive reciprocal relationships between distinct cognitive abilities during development. It predicts that abilities such as language and reasoning will influence each other's rates of growth. This may explain why children with Language Disorders also tend to have lower than average non-verbal cognitive abilities, as poor language would limit the rate of growth of other cognitive skills. The current study tests whether language and non-verbal reasoning show mutualistic coupling in children with and without language disorder using three waves of data from a longitudinal cohort study that over-sampled children with poor language at school entry (N = 501, 7-13 years). Bivariate Latent Change Score models were used to determine whether early receptive vocabulary predicted change in non-verbal reasoning and vice-versa. Models that included mutualistic coupling parameters between vocabulary and non-verbal reasoning showed superior fit to models without these parameters, replicating previous findings. Specifically, children with higher initial language abilities showed greater growth in non-verbal ability and vice versa. Multi-group models suggested that coupling between language and non-verbal reasoning was equally strong in children with language disorder and those without. This indicates that language has downstream effects on other cognitive abilities, challenging the existence of selective language impairments. Future intervention studies should test whether improving language skills in children with language disorder has positive impacts on other cognitive abilities (and vice versa), and low non-verbal IQ should not be a barrier to accessing such intervention.

Two-stage sampling in the estimation of growth parameters and percentile norms: sample weights versus auxiliary variable estimation.

BACKGROUND: The use of auxiliary variables with maximum likelihood parameter estimation for surveys that miss data by design is not a widespread approach, despite its documented improved efficiency over traditional approaches that deploy sampling weights. Although efficiency gains from the use of Normally distributed auxiliary variables in a model have been recorded in the literature, little is known about the effects of non-Normal auxiliary variables in the parameter estimation. METHODS: We simulate growth data to mimic SCALES, a two-stage survey of language development with a screening phase (stage one) for which data are observed for the whole sample and an intensive assessments phase (stage two), for which data are observed for a sub-sample, selected using stratified random sampling. In the simulation, we allow a fully observed Poisson distributed stratification criterion to be correlated with the partially observed model responses and develop five generalised structural equation growth models that host the auxiliary information from this criterion. We compare these models with each other and with a weighted growth model in terms of bias, efficiency, and coverage. We finally apply our best performing model to SCALES data and show how to obtain growth parameters and population norms. RESULTS: Parameter estimation from a model that incorporates a non-Normal auxiliary variable is unbiased and more efficient than its weighted counterpart. The auxiliary variable method is capable of producing efficient population percentile norms and velocities. CONCLUSIONS: The deployment of a fully observed variable that dominates the selection of the sample and correlates strongly with the incomplete variable of interest appears beneficial for the estimation process.

Atypicalities in sleep and semantic consolidation in autism.

Sleep is known to support the neocortical consolidation of declarative memory, including the acquisition of new language. Autism spectrum disorder (ASD) is often characterized by both sleep and language learning difficulties, but few studies have explored a potential connection between the two. Here, 54 children with and without ASD (matched on age, nonverbal ability and vocabulary) were taught nine rare animal names (e.g., pipa). Memory was assessed via definitions, naming and speeded semantic decision tasks immediately after learning (pre-sleep), the next day (post-sleep, with a night of polysomnography between pre- and post-sleep tests) and roughly 1 month later (follow-up). Both groups showed comparable performance at pre-test and similar levels of overnight change on all tasks; but at follow-up children with ASD showed significantly greater forgetting of the unique features of the new animals (e.g., pipa is a flat frog). Children with ASD had significantly lower central non-rapid eye movement (NREM) sigma power. Associations between spindle properties and overnight changes in speeded semantic decisions differed by group. For the TD group, spindle duration predicted overnight changes in responses to novel animals but not familiar animals, reinforcing a role for sleep in the stabilization of new semantic knowledge. For the ASD group, sigma power and spindle duration were associated with improvements in responses to novel and particularly familiar animals, perhaps reflecting more general sleep-associated improvements in task performance. Plausibly, microstructural sleep atypicalities in children with ASD and differences in how information is prioritized for consolidation may lead to cumulative consolidation difficulties, compromising the quality of newly formed semantic representations in long-term memory.

Does Inattention and Hyperactivity Moderate the Relation Between Speed of Processing and Language Skills?

The causal role of speed of processing (SOP) in developmental language disorder (DLD) is unclear given that SOP has been implicated in other neurodevelopmental disorders such as attention-deficit/hyperactivity disorder. This study investigated associations between SOP, language, and inattention/hyperactivity in a U.K. epidemiological cohort (N = 528). Monolingual children from a range of socioeconomic backgrounds were assessed longitudinally; at ages 5-6 (2012/2013) and 7-8 years (2014/2015). Persistent weaknesses in SOP characterized children with DLD but did not predict language longitudinally. Ratings of inattention/hyperactivity moderated the association between SOP and language, indicating that SOP deficits are particularly detrimental for language when coupled with poor attention/hyperactivity. SOP may be a shared risk factor for DLD and inattention/hyperactivity or a general marker of neurodevelopmental disorder.

Evidence-based pathways to intervention for children with language disorders.

BACKGROUND: Paediatric speech and language therapist (SLT) roles often involve planning individualized intervention for specific children, working collaboratively with families and education staff, providing advice, training and coaching and raising awareness. A tiered approach to service delivery is currently recommended whereby services become increasingly specialized and individualized for children with greater needs. AIMS: To stimulate discussion regarding delivery of SLT services by examining evidence regarding the effectiveness of (1) intervention for children with language disorders at different tiers and (2) SLT roles within these tiers; and to propose an evidence-based model of SLT service delivery and a flowchart to aid clinical decision-making. METHODS & PROCEDURES: Meta-analyses and systematic reviews, together with controlled, peer-reviewed group studies where recent systematic reviews were not available, of interventions for children with language disorders are discussed, alongside the differing roles SLTs play in these interventions. Gaps in the evidence base are highlighted. MAIN CONTRIBUTION: The service-delivery model presented resembles the tiered model commonly used in education services, but divides individualized (Tier 3) services into Tier 3A: indirect intervention delivered by non-SLTs, and Tier 3B: direct intervention by an SLT. We report evidence for intervention effectiveness, which children might best be served by each tier, the role SLTs could take within each tier and the effectiveness of these roles. Regarding universal interventions provided to all children (Tier 1) and those targeted at children with language weaknesses or vulnerabilities (Tier 2), there is growing evidence that approaches led by education services can be effective when staff are highly trained and well supported. There is currently limited evidence regarding additional benefit of SLT-specific roles at Tiers 1 and 2. With regard to individualized intervention (Tier 3), children with complex or pervasive language disorders can progress following direct individualized intervention (Tier 3B), whereas children with milder or less pervasive difficulties can make progress when intervention is managed by an SLT, but delivered indirectly by others (Tier 3A), provided they are well trained and supported, and closely monitored. CONCLUSIONS & IMPLICATIONS: SLTs have a contribution to make at all tiers, but where prioritization for clinical services is a necessity, we need to establish the relative benefits and cost-effectiveness at each tier. Good evidence exists for SLTs delivering direct individualized intervention and we should ensure that this is available to children with pervasive and/or complex language disorders. In cases where service models are being provided which lack evidence, we strongly recommend that SLTs investigate the effectiveness of their approaches.

How do parents of school-aged children respond to their children's extending gestures?

Gesture plays an important role in early language development, as how parents respond to their children's gestures may help to facilitate language acquisition. Less is known about whether parental responses facilitate language learning later in childhood and whether responses vary depending on children's language ability. This study explored parental responses to extending gestures in a sample of school-aged children (aged six to eight years) with developmental language disorder, low-language and educational concerns, and typically developing children. Overall there were no group differences in the types of responses parents provided to extending gestures. Parents predominantly responded with positive feedback but also displayed moderate proportions of verbal translations and clarification requests. Within the DLD group, the proportion of parent translations was negatively associated with language ability. Our finding suggests that parent responses serve to enhance communication and engage children in tasks, but there is limited evidence that they support new language learning at this age.

One size does not fit all: addressing the challenges of intervention for complex developmental issues.

The Journal of Child Psychology and Psychiatry is committed to publishing implementational research, or turning therapeutic research discoveries into practical benefit for human health and well-being. This editorial showcases three such papers in this issue from diverse fields in developmental science. The papers highlight the challenges of implementing intervention under real-world constraints, and highlight key issues that clinicians and researchers will need to address in future work. Despite these challenges, each approach shows promise and innovation in delivering high-quality interventions to vulnerable children and families.

Acquisition of abstract concepts is influenced by emotional valence.

There is considerable lack of evidence concerning the linguistic and cognitive skills underpinning abstract vocabulary acquisition. The present study considers the role of emotional valence in providing an embodied learning experience in which to anchor abstract meanings. First, analyses of adult ratings of age-of-acquisition, concreteness and valence demonstrate that abstract words acquired early tend to be emotionally valenced. Second, auditory Lexical Decision accuracies of children aged 6-7, 8-9, and 10-11 years (n = 20 per group) complement these analyses, demonstrating that emotional valence facilitates processing of abstract words, but not concrete. These findings provide the first evidence that young, school-aged children are sensitive to emotional valence and that this facilitates acquisition of abstract words.

Editorial: New frontiers in the scientific study of developmental language disorders.

Developmental language disorders (DLD) are common and have far-reaching developmental consequences. Nevertheless, public awareness of DLD is poor, and one goal of this special issue is to showcase a set of papers that provide a clear and coherent message about the nature and impact of DLD, and the potential of intervention to mitigate these impacts. In this editorial, we highlight seminal papers JCPP has published on language disorders over the last 40 years. Many of the issues raised then are still relevant now; however, the papers that comprise this special issue exemplify how far the field has come in achieving consensus on terminology and diagnostic criteria, and producing highly consistent findings on the stability and impact of DLD, and the potential for language change in response to targeted interventions. The editorial concludes with a road map for future research and clinical priorities that includes the need for randomised controlled trials that specifically address the impact of co-morbidities on response to treatment, impacts of intervention on broader developmental outcomes, and the experiences of adults with DLD.

Language growth in children with heterogeneous language disorders: a population study.

BACKGROUND: Language development has been characterised by significant individual stability from school entry. However, the extent to which trajectories of language growth vary in children with language disorder as a function of co-occurring developmental challenges is a question of theoretical import, with implications for service provision. METHODS: SCALES employed a population-based survey design with sample weighting procedures to estimate growth in core language skills over the first three years of school. A stratified sample (n = 529) received comprehensive assessment of language, nonverbal IQ, and social, emotional and behavioural difficulties at 5-6 years of age and 95% of the sample (n = 499) were assessed again at ages 7-8. Language growth was measured using both raw and standard scores in children with typical development, children with language disorder of unknown origin, and children with language disorders associated with a known clinical condition and/or intellectual disability. RESULTS: Overall, language was stable at the individual level (estimated ICC = 0.95) over the first three years of school. Linear mixed effects models highlighted steady growth in language raw scores across all three groups, including those with multiple developmental challenges. There was little evidence, however, that children with language disorders were narrowing the gap with peers (z-scores). Adjusted models indicated that while nonverbal ability, socioeconomic status and social, emotional and behavioural deficits predicted initial language score (intercept), none predicted language growth (slope). CONCLUSIONS: These findings corroborate previous studies suggesting stable language trajectories after ages 5-6 years, but add considerably to previous work by demonstrating similar developmental patterns in children with additional nonverbal cognitive deficits, social, emotional, and behavioural challenges, social disadvantage or clinical diagnoses.

Does a child's language ability affect the correspondence between parent and teacher ratings of ADHD symptoms?

BACKGROUND: Rating scales are often used to identify children with potential Attention-Deficit/Hyperactivity Disorder (ADHD), yet there are frequently discrepancies between informants which may be moderated by child characteristics. The current study asked whether correspondence between parent and teacher ratings on the Strengths and Weakness of ADHD symptoms and Normal behaviour scale (SWAN) varied systematically with child language ability. METHOD: Parent and teacher SWAN questionnaires were returned for 200 children (aged 61-81 months); 106 had low language ability (LL) and 94 had typically developing language (TL). After exploring informant correspondence (using Pearson correlation) and the discrepancy between raters, we report inter-class correlation coefficients, to assess inter-rater reliability, and Cohen's kappa, to assess agreement regarding possible ADHD caseness. RESULTS: Correlations between informant ratings on the SWAN were moderate. Children with LL were rated as having increased inattention and hyperactivity relative to children with TL; teachers, however, rated children with LL as having more inattention than parents. Inter-rater reliability of the SWAN was good and there were no systematic differences between the LL and TL groups. Case agreement between parent and teachers was fair; this varied by language group with poorer case agreement for children with LL. CONCLUSION: Children's language abilities affect the discrepancy between informant ratings of ADHD symptomatology and the agreement between parents and teachers regarding potential ADHD caseness. The assessment of children's core language ability would be a beneficial addition to the ADHD diagnostic process.

English Language Proficiency and Early School Attainment Among Children Learning English as an Additional Language.

Children learning English as an additional language (EAL) often experience lower academic attainment than monolingual peers. In this study, teachers provided ratings of English language proficiency and social, emotional, and behavioral functioning for 782 children with EAL and 6,485 monolingual children in reception year (ages 4-5). Academic attainment was assessed in reception and Year 2 (ages 6-7). Relative to monolingual peers with comparable English language proficiency, children with EAL displayed fewer social, emotional, and behavioral difficulties in reception, were equally likely to meet curriculum targets in reception, and were more likely to meet targets in Year 2. Academic attainment and social, emotional, and behavioral functioning in children with EAL are associated with English language proficiency at school entry.

Evaluation of an interview skills training package for adolescents with speech, language and communication needs.

BACKGROUND & AIMS: We evaluated a structured intervention programme aimed at preparing adolescents with developmental language disorders for job interviews. Our primary outcome measures included change in ratings of verbal and non-verbal social communication behaviours evident during mock interviews. METHODS & PROCEDURES: In study 1, 12 participants, aged 17-19 years, from a specialist sixth-form college completed the intervention and two mock interviews, one pre- and one post-intervention. In study 2, 34 participants, aged 17-19 years, completed a modified intervention programme and three mock interviews, one at baseline (included to control for possible practise effects), one pre- and one post-intervention. In both studies, interviews were video recorded and social communication behaviours were coded by independent assessors blind to interview time, participant diagnosis and therapy content. A repeated-measures design was employed to measure change in communication behaviours. OUTCOMES & RESULTS: In study 1, a significant increase in the number of 'positive' verbal and non-verbal social communication behaviours was observed from pre- to post-intervention. However, there was no significant change in the number of 'negative' behaviours (i.e., fidgeting, irrelevant remarks). In study 2, there were no significant changes in verbal behaviours, but significant group differences (though wide individual variation) in both positive and negative non-verbal social communication behaviours. CONCLUSIONS & IMPLICATIONS: Our findings suggest that training specific social communication skills that are important for interview success, and consistently reinforcing those behaviours during therapy practice, can increase the use of those skills in an interview setting, though in this heterogeneous population there was considerable variation in therapy outcome. The skills of the interviewer were identified as a potential source of variation in outcome, and a target for future research and practice.

Editorial: The search for core symptoms - will this help clinical decision-making?

Diagnosis is an important component of our clinical roles, and should also lead to particular treatment pathways. The diagnostic process may be challenged by co-occurring deficits that are neither specific nor universal to the diagnosis under consideration and may well be evident across a range of other clinical conditions. How important is it to refine our instruments so that they measure unique symptoms? Will this alter or improve intervention choices? This Editorial focuses on the extent to which fine tuning diagnostic instruments improves our decisions about treatment, in the context of articles published in this issue of JCPP.

Younger children experience lower levels of language competence and academic progress in the first year of school: evidence from a population study.

BACKGROUND: The youngest children in an academic year are reported to be educationally disadvantaged and overrepresented in referrals to clinical services. In this study we investigate for the first time whether these disadvantages are indicative of a mismatch between language competence at school entry and the academic demands of the classroom. METHODS: We recruited a population sample of 7,267 children aged 4 years 9 months to 5 years 10 months attending state-maintained reception classrooms in Surrey, England. Teacher ratings on the Children's Communication Checklist-Short (CCC-S), a measure of language competence, the Strengths and Difficulties Questionnaire-Total Difficulties Score (SDQ), a measure of behavioural problems, and the Early Years Foundation Stage Profile (EYFSP), a measure of academic attainment, were obtained at the end of the reception year. RESULTS: The youngest children were rated by teachers as having more language deficits, behaviour problems, and poorer academic progress at the end of the school year. Language deficits were highly associated with behaviour problems; adjusted odds ratio 8.70, 95% CI [7.25-10.45]. Only 4.8% of children with teacher-rated language deficits and 1.3% of those with co-occurring language and behaviour difficulties obtained a 'Good Level of Development' on the EYFSP. While age predicted unique variance in academic attainment (1%), language competence was the largest associate of academic achievement (19%). CONCLUSION: The youngest children starting school have relatively immature language and behaviour skills and many are not yet ready to meet the academic and social demands of the classroom. At a population level, developing oral language skills and/or ensuring academic targets reflect developmental capacity could substantially reduce the numbers of children requiring specialist clinical services in later years.

The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study.

BACKGROUND: Diagnosis of 'specific' language impairment traditionally required nonverbal IQ to be within normal limits, often resulting in restricted access to clinical services for children with lower NVIQ. Changes to DSM-5 criteria for language disorder removed this NVIQ requirement. This study sought to delineate the impact of varying NVIQ criteria on prevalence, clinical presentation and functional impact of language disorder in the first UK population study of language impairment at school entry. METHODS: A population-based survey design with sample weighting procedures was used to estimate population prevalence. We surveyed state-maintained reception classrooms (n = 161 or 61% of eligible schools) in Surrey, England. From a total population of 12,398 children (ages 4-5 years), 7,267 (59%) were screened. A stratified subsample (n = 529) received comprehensive assessment of language, NVIQ, social, emotional and behavioural problems, and academic attainment. RESULTS: The total population prevalence estimate of language disorder was 9.92% (95% CI 7.38, 13.20). The prevalence of language disorder of unknown origin was estimated to be 7.58% (95% CI 5.33, 10.66), while the prevalence of language impairment associated with intellectual disability and/or existing medical diagnosis was 2.34% (95% CI 1.40, 3.91). Children with language disorder displayed elevated symptoms of social, emotional and behavioural problems relative to peers, F(1, 466) = 7.88, p = .05, and 88% did not make expected academic progress. There were no differences between those with average and low-average NVIQ scores in severity of language deficit, social, emotional and behavioural problems, or educational attainment. In contrast, children with language impairments associated with known medical diagnosis and/or intellectual disability displayed more severe deficits on multiple measures. CONCLUSIONS: At school entry, approximately two children in every class of 30 pupils will experience language disorder severe enough to hinder academic progress. Access to specialist clinical services should not depend on NVIQ.

Referring expressions and structural language abilities in children with specific language impairment: A pragmatic tolerance account.

Specific language impairment (SLI) has traditionally been characterized as a deficit of structural language (specifically grammar), with relative strengths in pragmatics. In this study, comprehensive assessment of production, comprehension, and metalinguistic judgment of referring expressions revealed that children with SLI have weaknesses in both structural and pragmatic language skills relative to age-matched peers. Correlational analyses highlight a relationship between their performance on the experimental tasks and their structural language ability. Despite their poor performance on the production and comprehension tasks, children with SLI were able to recognize pragmatically under-informative reference relative to other types of utterance, although they imposed a less severe penalty on such expressions than typically developing peers, a pattern that supports the pragmatic tolerance account. Our novel methodology (which probed structural abilities from both the speaker's and hearer's perspectives as well as metalinguistic and pragmatic skills in the same sample) challenges the assumption that pragmatic errors stem from deficits in social cognition and instead supports recent findings suggesting that when the impact of structural language is isolated, pragmatic deficits may be resolved.