SLI

Question 1

structure of language

Answer 1

Language subsystems:
Phonology: speech sounds signal differences in meaning (e.g. cat vs car; tall vs tool)
Grammar:
Syntax: system of rules in sentences (e.g. I am going now vs I now going) and
Morphology: structure of words and units of meaning – morphemes (e.g. help, help-ed, help-ing, help-less)
Semantics: meaning at sentence and word level (e.g. the dog chased the cat vs the green blued the red)
Pragmatics: how language used in context – understanding others’ assumptions (e.g. Q - what did you have for dinner?; A - food)?

Question 2

theories of language acquisition

Answer 2

Innate view (Chomsky): children are born with an inherited ability to learn language; innate linguistic structures, particularly mechanisms for abstraction of grammatical rules; problems with grammar (as in) SLI results from genetic abnormalities (Gopnik & Crago, 1991)
Learned (Skinner): dependent on linguistic input child exposed to; SLI results from the child’s linguistic environment
Interactionist: language dependent on innate ability and exposure to language; SLI results from an interaction between genetics, cognitive development and linguistic environment

Question 3

stages of language acquisition

Answer 3

Pre-linguistic stage (birth – 12 months)
cooing, babbling and nonverbal communication
Holophrastic stage (12 – 18 months)
linguistic communication using one-word utterances (e.g. ‘food’ ‘milk’ ‘up’ ‘mummy’)
Telegraphic stage (18 months – 2½ years)
syntax is emerging but many syntactic elements are still missing (like a telegram)
Syntactic stage (2½ years +)
grammatical morphemes, pluralisation, transformational rules

Question 4

definition and preevalence of SLI

Answer 4

“An isolated significant delay in the proper use of communicative expressive or receptive language in the absence of observed cognitive impairment, hearing loss or abnormal social interactions” (Nass & Koch, 1992)
Prevalence estimates range from 3% to 6% - not a static condition (some children resolve difficulties with age)
More boys than girls: ratios range from 3:1 to 4:1
Other terms: developmental language disorder, language delay, developmental dysphasia

Question 5

symptoms of SLI

Answer 5

Delayed onset and slow rate of development of language/speech
Child’s oral language skills are much worse than expected given their nonverbal ability
Children with SLI usually have more difficulties with language production than comprehension
Children with SLI may also have difficulties with comprehension as well

Question 6

subtypes of SLI

Answer 6

Expressive language disorder: primarily affects production of language (speaking), where there is no delay in non-verbal intelligence
Mixed expressive-receptive disorder: affects language comprehension (understanding) and production (speaking), where there is no delay in non-verbal intelligence

Question 7

comorbidity in SLI

Answer 7

SLI often associated with:
reading disorders
motor co-ordination disorder
general learning difficulties (low NVIQ)

Later outcomes:
increased risk of psychiatric disorders
difficulties with attention
social impairments
Autism

Question 8

specific implications of SLI

Answer 8

for social skills:
Children with a range of language disorders can have social and emotional difficulties (Spackman, Fujike & Brinton, 2005)
Children can be excluded from games where there is significant language content
for beh:
A survey of young offenders found that 66% to 90% of juvenile offenders in the sample had below average language skills and 46% to 67% had poor to very poor language skills
Comorbidity rate of language and behavioural difficulties is about 50 to 70% (Redmond and Rice 1998)
Baker and Cantwek (1987) reported an increase in psychiatric disorders
for literacy:
In a survey of 82 children in a special school for children with SLI, only 7 did not have reading problems (Haynes & Naidoo, 1991)
Children whose language difficulties had ‘normalised’ by 5 ½ continued to have difficulties with phonological processing and literacy difficulties in adolescence (Stothard et al., 1998)
for numeracy:
Mathematical competence of adolescents is compromised by early language impairment (Aram & Nation, 1980; Snowling et al., 2001)
Cowan et al. (2005) found that the number skills of SLI children were poorer compared with controls

Question 9

DSM 5 of SLI

Answer 9

A) Persistent difficulties in the acquisition and use of language across modalities (i.e. spoken, written, sign language) due to deficits in comprehension or production that include the following:
Reduced vocabulary (word knowledge and use)
Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology
Impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation
B) . Language abilities are substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, individually or in any combination
C. Onset of symptoms is in the early developmental period
D. The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and are not better explained by intellectual disability or global developmental delay

Question 10

ICD 10 of SLI

Answer 10

Language skills, as assessed on standardised tests, more than 2 SDs below average for age
Language skills are at least 1 SD below nonverbal IQ as assessed on standardised tests
There are no neurological, sensory, or physical impairments that directly affect use of spoken language, nor a pervasive developmental disorder (e.g. autism)
A distinction is made between receptive language disorder, where comprehension is more than 2 SDs below average for age, and expressive language disorder, where only expressive language is so severely affected and comprehension is within 2 SDs of average for age

Question 11

theories of SLI

Answer 11

cognitive theories:
Speed and capacity limitations: children with SLI have speed and processing deficits – a general capacity limitation
Auditory processing deficits: children with SLI have difficulty processing rapidly changing auditory information which compromises their speech perception
Phonological memory deficits: children with SLI have specific difficulties with phonological memory – deficits on nonword repetition
Word learning deficits: children with SLI show slow acquisition of words which explains language deficits

linguistic theories of SLI:
Problem with grammatical paradigms: children with SLI are ‘blind’ to syntactic-semantic features, e.g. plurality, gender, tense
Extended optional infinitive: grammatical development of SLI is within the Extended Optional Infinitive (EOI) stage; children with SLI have specific difficulties in representing the finiteness of verbs; they use immature grammar for much longer than non-SLI children, e.g. “Granny see me”
BUT these theories focus on showing that a particular deficit exists in children with SLI – not on WHY this component of language fails to develop

hybrid theories:
Surface hypothesis: morphemes are vulnerable in English due to their surface properties, particularly where there are resource limitations; children with SLI have processing limitation, which compromises the processing of morphemes, particularly those of brief duration (e.g. -ed, -s, to)
Connectionism: high-level syntactic deficits in children with SLI are due to lower-level deficits in phonological encoding and representation, caused by auditory perceptual deficits

Question 12

risk factors for SLI

Answer 12

env:
In normally developing children there are wide variations in language skills when starting school
Quality of linguistic environment at home: speaking directly to children, encouraging children to talk, parents’ use of decontextualized language, diverse / complex vocabulary
Glue ear (infection of the middle ear): recurrent episodes could affect speech perception and general language acquisition
Association between SLI and toxemia (toxemia causes foetal anoxia)

genetic:
Heritability varies depending on the nature and severity of the language deficit
Twin studies:lewis and thompsom; bishop; tomblin and buckwalter
FOXP2 mutation on chromosome 7: however perhaps associated only with orofacial motor control
Four chromosome regions have been identified: but much more research required

Question 13

variations in diagnosing SLI

Answer 13

Variations in diagnosing SLI:
SLI Consortium (2004):
expressive or receptive language, or both, at least 1.5 SDs below average for age
non-verbal IQ 80+
Tomblin, Records & Zhang (1996):
at least 1.25 SDs below average on two of five language scores (vocabulary, grammar, narrative, expressive and receptive)
non-verbal IQ 85+
Typical sensory and socio-motor development

Question 14

assessment tools for SLI

Answer 14

Non-verbal IQ:
WPPSI-III: 2:6-7:3; nonverbal IQ (Block Design, Matrix Reasoning, Picture Concepts, Object Assembly)
WISC-V: 6-16; Block Design, Matrix Reasoning, Picture Concepts, Visual Puzzles, Figure Weights
BAS-III: 3-17; Picture Similarities, Matrices, Quantitative Reasoning
Auditory discrimination:
Wepman Test: 4-8; identify if word pairs are same / different
Goldman-Fristoe-Woodcock Test of Auditory Discrimination: 3-70; quiet and noisy environments
Phonological abilities:
PhAB: 6-14; Alliteration, Naming, Rhyme, Spoonerisms, Fluency
PAT-2: 5-9; Rhyming, Segmentation, Isolation, Deletion, Substitution, Blending, Graphemes, Decoding
Vocabulary (expressive and receptive):
EVT-2: 2-90; expressive vocabulary and word retrieval
PPVT-4: 2-90; receptive vocabulary
BPVS-3: 3-16; receptive vocabulary
BAS-III: 3-17; Word Definitions
WPPSI-III: 2:6-7:3; Vocabulary, Receptive Vocabulary
Language (expressive and receptive):
Reynell Developmental Language Scales: 3-7; production and understanding of spoken language
Assessment of Comprehension and Expression: 6-11; Sentence Comprehension; Inferential Comprehension, Naming, Syntactic Formulation, Semantic Decisions, Non-literal Comprehension, Narrative
OWLS: 3-21; Listening Comprehension, Oral Expression

Question 15

interventions for SLI

Answer 15

Interventions focus on targeting specific speech and language difficulties of the child
Law, Garret and Nye (2004): Interventions focusing on expressive phonology and vocabulary development were more effective than interventions focusing on expressive syntax or receptive language skills
Computerised training programs: e.g. Fast ForWord
Use of language in natural settings
Speech and Language Therapy

Question 16

Speech and language therapists

Answer 16

Ways a SALT might support the child include :
Training and advice for parents/carers and other service providers (health, social work, education)
Provision of programmes of work and ways of supporting the child in different environments and by different people
Assessment and provision of communication aids and resources
Involvement with educational and transition planning
Direct therapy with child individually or in a group

Law, Garrett and Nye (2004):
25 studies were used in the meta-analysis
Speech and language therapy is effective for children with phonological and vocabulary difficulties
Less evidence that interventions are effective for children with receptive difficulties
No significant differences were shown between clinician-administered intervention and intervention implemented by trained parents
No significant difference between the effectiveness of group and individual interventions
The involvement of non-SLI peers in therapy was shown to have a positive effect on therapy outcome

Question 17

classroom strategies for receptive lang difficulties

Answer 17

Reduce background noise by moving the child away from groups with which they are not involved, high traffic areas and environmental noises
Speak at a slower rate
Present verbal information in short chunks
Reduce the complexity of verbal and written instructions
Repeat instructions
Accompany verbal directions with written ones, picture or symbol cues
Allow extra time for the child to process verbal or written information
Allow the use of compensatory tools, e.g. tape recorder or note taker
Provide child with as much feedback as possible
Encourage the child to identify and request clarification of specific information or vocabulary they are not understanding
Be aware that the child may need extra support to be involved in group discussions

Question 18

classroom strategies for expressive lang difficulties

Answer 18

Allow extra time if the child needs this to express themselves
Child could have difficulties with sequencing oral/written information - provide appropriate visual or auditory prompts to help them structure their thoughts or phrases
Use question prompts to help the child expand expressive language: who, what, when, where, why and how questions
Motivate child to speak by setting up conversational openings and allow time for the child to talk about what they are interested in
Help other children to support the child and encourage other children to interact with them
If the child makes a mistake, do not correct them or make them repeat the sentence/phrase, rather model the correct answer for them
Use play activities as an opportunity to model and extend language
If child is a reluctant communicator, reward all efforts at spontaneous interaction

Question 19

persistence and general implications of SLI

Answer 19

general implications:
Children with delay in comprehension and expression have poorer prognosis than those whose delay is confined to one or other category (Silva & Ferguson, 1980)
Language disordered children with higher non-verbal IQ tend to make better progress (Paul and Cohen, 1984)

persistence:
50-90% of children with SLI have persistent language difficulties through childhood
Bishop and Edmundson (1987): 44% of children diagnosed with SLI at age 4 language impairment resolved within 18 months
Bishop and Adams (1990): follow up of previous study found those in the resolved SLI group at 5½ showed good outcomes at 8½; those still diagnosed with SLI at 5½ continued to show language impairments
Stothard et al. (1998): final follow-up at age 15-16: those still SLI at 5½ show severe impairments in all aspects of language; those who were resolved at 5½ show deficits on phonological skills and literacy and achieved poorer grades at GCSE
Academic difficulties in adolescence are common in individuals with a history of SLI

Question 20

implications of SLI for placement and general attainment

Answer 20

general attainment:
Each National Curriculum subject presents its own particular challenge for children with language disorders, where the child has to speak and listen for a wide range of purposes in different contexts
Each subject has its own vocabulary which is only acquired as the child has reason to use it and needs to understand it
Each child needs:
Communicative language: conversational fluency
Cognitive language: language used to develop and structure ideas
Academic language: characterised by a passive voice, the use of metaphor and personification

placement:
“There was little difference in the quality of provision and outcomes for pupils across primary and secondary mainstream schools and special schools. However, mainstream schools with additionally resourced provision were particularly successful in achieving high outcomes for pupils academically, socially and personally. PRUs were the least successful.” (Ofsted, 2006)
National Curriculum Statement on inclusion - some children might require:
opportunities to meet the demands for speaking and listening through the use of alternative communication systems
opportunities to develop alternative methods of recording, including using ICT
use of tactile methods; assessment will through the use of material presented in the appropriate medium