Narrative competence in children with pragmatic language impairment: a longitudinal study.

BACKGROUND: Children with pragmatic language impairment (PLI) show impairments in the use of language in social contexts. Although the issue has been gaining attention in recent literature, not much is known about the developmental trajectories of children who experience pragmatic language problems. Since narrative competence is an important predictor of both academic and social success, evaluating narrative competence in children with PLI is deemed important. AIMS: To examine the development of narrative competence of children with PLI compared with typically developing (TD) children using a prognostic longitudinal design. METHODS & PROCEDURES: Using the Dutch adaptation of the Renfrew Bus Story Test, narrative competence was assessed at ages 5-7 for a group of 84 children with PLI and a group of 81 TD children. Groups were compared on measures of narrative productivity, organization of story content and cohesion. OUTCOMES & RESULTS: Results showed an increase in narrative competence for both groups across most time points. The PLI group obtained lower scores on measures of narrative productivity and story content organization compared with their TD peers at all time points, but did not show more problems related to narrative cohesion. Most problems in the domain of narrative productivity and story content organization were shown to be independent of lower non-verbal intelligence. The developmental trajectory for the PLI group was largely similar to that of their TD peers, and showed a persistent developmental delay of approximately one year. Furthermore, qualitative differences were visible in the proportion of irrelevant T-units, which was consistently higher in the PLI group. The different narrative measures were found to be relatively stable over time. CONCLUSIONS & IMPLICATIONS: The results of this study suggest that narrative difficulties of children identified as pragmatically impaired persist at least until middle childhood. The persistence of the measured developmental delay, combined with the finding of qualitative differences, support the view of PLI as a deficit, which is consistent with the addition of social communication disorder (SCD) to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Pragmatic language impairment and associated behavioural problems.

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.

Developmental Associations Between Working Memory and Language in Children With Specific Language Impairment: A Longitudinal Study.

Purpose: This longitudinal study examined differences in the development of working memory (WM) between children with specific language impairment (SLI) and typically developing (TD) children. Further, it explored to what extent language at ages 7-8 years could be predicted by measures of language and/or WM at ages 4-5 years. Method: Thirty children with SLI and 33 TD children who were previously examined on measures of WM and language at ages 4-5 years (T1) were reexamined at ages 7-8 years (T2). Results: The developmental course of WM was mostly similar for the two groups; only the development of the verbal storage component differed. At T1, children with SLI performed significantly below their TD peers on all components of WM (verbal storage, verbal central executive [CE], visuospatial storage, and visuospatial CE), whereas at T2, the differences for the visuospatial components were no longer significant when age and intelligence were taken into account. Hierarchical regression showed language and verbal CE at T1 to be significant predictors of language at T2, with no differences in the developmental associations between language and WM for the two groups. Conclusions: The results of this study suggest that particularly verbal CE is of importance for the acquisition of linguistic skills.

Interactions between working memory and language in young children with specific language impairment (SLI).

The underlying structure of working memory (WM) in young children with and without specific language impairment (SLI) was examined. The associations between the components of WM and the language abilities of young children with SLI were then analyzed. The Automated Working Memory Assessment and four linguistic tasks were administered to 58 children with SLI and 58 children without SLI, aged 4-5 years. The WM of the children was best represented by a model with four separate but interacting components of verbal storage, visuospatial storage, verbal central executive (CE), and visuospatial CE. The associations between the four components of WM did not differ significantly for the two groups of children. However, the individual components of WM showed varying associations with the language abilities of the children with SLI. The verbal CE component of WM was moderately to strongly associated with all the language abilities in children with SLI: receptive vocabulary, expressive vocabulary, verbal comprehension, and syntactic development. These results show verbal CE to be involved in a wide range of linguistic skills; the limited ability of young children with SLI to simultaneously store and process verbal information may constrain their acquisition of linguistic skills. Attention should thus be paid to the language problems of children with SLI, but also to the WM impairments that can contribute to their language problems.

Working memory performance and executive function behaviors in young children with SLI.

The present study compared the performances of young children with specific language impairment (SLI) to that of typically developing (TD) children on cognitive measures of working memory (WM) and behavioral ratings of executive functions (EF). The Automated Working Memory Assessment was administered to 58 children with SLI and 58 TD children aged 4 and 5 years. Additionally, parents completed the Behavior Rating Inventory of Executive Function - Preschool Version. The results showed the SLI group to perform significantly worse than the TD group on both cognitive and behavioral measures of WM. The deficits in WM performance were not restricted to the verbal domain, but also affected visuospatial WM. The deficits in EF behaviors included problems with inhibition, shifting, emotional control, and planning/organization. The patterns of associations between WM performance and EF behaviors differed for the SLI versus TD groups. WM performance significantly discriminated between young children with SLI and TD, with 89% of the children classified correctly. The data indicate domain general impairments in WM and problems in EF behaviors in young children with SLI. Attention should thus be paid to WM - both verbal and visuospatial - and EF in clinical practice. Implications for assessment and remediation were discussed.

Visuospatial working memory in specific language impairment: a meta-analysis.

We conducted a meta-analysis of the data from studies comparing visuospatial working memory (WM) in children with specific language impairment (SLI) and typically developing (TD) children. The effect sizes of 21 studies (including 32 visuospatial storage tasks and 9 visuospatial central executive (CE) tasks) were identified via computerized database searches and the reference sections of the identified studies. Meta-analyses and moderator analyses were conducted to examine the magnitude of the differences in visuospatial storage and CE, and their relation to the inclusion criteria used for SLI and the age of the children. The results showed significant effect sizes for visuospatial storage (d=0.49) and visuospatial CE (d=0.63), indicating deficits in both components of visuospatial WM in children with SLI. The moderator analyses showed that greater impairment in visuospatial storage was associated with more pervasive language impairment, whereas age was not significant associated with visuospatial WM. The finding of deficits in visuospatial WM suggests domain-general impairments in children with SLI. It raises questions about the language-specificity of a diagnosis of SLI. Careful attention should thus be paid to both verbal and visuospatial WM in clinical practice, and especially in those children with pervasive language impairments.

Semantic abilities in children with pragmatic language impairment: the case of picture naming skills.

PURPOSE: The semantic abilities of children with pragmatic language impairment (PLI) are subject to debate. The authors investigated picture naming and definition skills in 5-year-olds with PLI in comparison to typically developing children. METHOD: 84 children with PLI and 80 age-matched typically developing children completed receptive vocabulary, picture naming, and definition tasks. RESULTS: The PLI group scored lower on the receptive vocabulary and picture naming tasks. Word length and frequency affected naming accuracy in both groups. Children with PLI showed higher numbers of semantic errors, nonrelated errors, and omissions and circumlocutions. The error-type distribution differed between groups: PLI children showed disproportionate levels of nonrelated errors. In the definition task, PLI children showed lower information accuracy for accurately named pictures and comparable accuracy for incorrectly named pictures. Qualitative analysis suggested a high incidence of pragmatically inappropriate definitions for the PLI group. Naming accuracy for both groups improved equally after giving semantic cues. CONCLUSIONS: These findings suggest a deficit in object identification and/or naming selection. It might be premature to conclude that children with PLI show normal semantic abilities. The results are largely consistent with a general language delay; however, there is also some evidence of a qualitative difference between both groups.

Screening for pragmatic language impairment: the potential of the children's communication checklist.

The present study examines the validity of the Dutch Children's Communication Checklist (CCC) for children in kindergarten in a community sample, in order to assess the feasibility of using it as a screening instrument in the general population. Teachers completed the CCC for a representative sample of 1396 children at kindergarten level, taken from 53 primary schools in The Netherlands. The CCC was also completed for a clinical group consisting of children with SLI in special education. Reliability as measured with internal consistency scores was found to be good for the community sample. With regard to the construct validity, a five-factor second-order factor model was found when the pragmatic subscales were analysed, which provided a reasonable fit. Criterion validity as measured using the concordance between the CCC and teacher opinions was moderate. The children identified by the CCC as having Pragmatic Language Impairment (defined as scoring below the cut off of 132) were often characterized by the teachers as having social-emotional problems, language problems or combined problems. Comparison with a clinical SLI sample showed the pragmatically impaired children in the community sample to have a profile similar to that of the clinical group of children with PLI in special education. The main difference was visible in structural language problems, which were less severe for the PLI group in mainstream education. The results of this study suggest that screening for PLI is indeed possible using the CCC.