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High rates of language impairment in vulnerable populations: the case for improving cross-sector awareness of Developmental Language Disorder.

Hannah M. Hobson1* and Geoffrey Bird2, 3
  • 1 University of Greenwich, United Kingdom
  • 2 University of Oxford, United Kingdom
  • 3 Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom

Developmental Language Disorder (DLD) is a neurodevelopmental condition in which children do not achieve typical levels of language skill. These children may experience difficulties with structural aspects (i.e. syntactic, lexical and phonological problems) as well as pragmatic aspects of language. The prevalence rate of DLD is approximately 7.5% (Norbury et al., 2016). Thus, in a typical UK classroom of 30 students, we can expect on average two children to have DLD. Despite its relative prevalence compared to more widely known conditions such as autism (which has an estimated prevalence of around 1%; Baird et al., 2006), DLD is not well known. This is partly due to a historic lack of agreement on the criteria and terminology for DLD; recent efforts have been made to reach consensus on these issues (Bishop et al., 2016). However, the goal of increased awareness of DLD is not yet reached, and in the meantime, poor awareness of DLD has implications for children’s wellbeing and long-term outcomes. It is unsurprising, given the oral language and literacy demands of most education systems, that children with DLD show poorer academic outcomes compared to typically developing children (Johnson, Beitchman, & Brownlie, 2010). However, children with DLD may also face problems with their attendance: children who are school-refusers have poorer language skills overall, and a higher incidence of language impairments (Naylor, Staskowsi, Kenney & King, 1994). Language problems are also associated with exclusions from school; excluded children show higher rates of expressive language difficulties (Ripley & Yuill, 2005), and studies of mainstream secondary school pupils facing exclusion suggest that two thirds have language problems, with one third showing severe language problems (Clegg, Stackhouse, Finch, Murphy, & Nicholls, 2009). Of the 15 children assessed for this study, only one had received speech and language therapy (for a stammer); none of the other children had been assessed by a speech and language therapist. All children had been excluded three or more times, and were at risk of being permanently excluded from school. Language impairment is also elevated in mental health services. The high rate of language problems in children and adolescents accessing support for emotional and behavioural problems has been summarised in a meta-analysis of 22 studies (Hollo, Wehby, & Oliver, 2014): approximately 81% of children accessing help for an emotional-behavioural disorder have below-average language proficiency, and that 47% of children show moderate to severe language problems. None of the children in the studies had previously been assessed for speech or language problems. As yet, there is no data to indicate whether the high rate of language problems in these services has an impact on progress in psychological therapy. Language problems also show relationships to involvement with the criminal justice system. Language-impaired youth have higher rates of arrests and convictions (Brownlie et al., 2004), and the rate of language impairment in young offender institutions is elevated (see Anderson, Hawes, & Snow, 2016 for a systematic review). A recent study found that 47% of the 93 young offenders assessed showed language skills significantly below what would be expected for their age, and 20% would have met the criteria for language impairment (Hughes et al., 2017). The majority of those identified as having a language impairment had not previously worked with a speech and language therapist. It is thus clear that in a variety of different vulnerable populations we see higher rates of language impairment than would be expected given the prevalence in the general population, and that many of these cases go undetected. It is important to emphasise that many children with DLD go on to have good outcomes, and that language impairment is not deterministic of the problems discussed here (see Johnson et al, 2010). This is important, as it suggests firstly that there are factors that moderate the relationship between language problems and wellbeing, and secondly because it offers hope that, with appropriate identification and support, children with DLD can have good outcomes. Nonetheless, a pertinent question is why are rates of DLD increased across these different settings? There are number of plausible reasons. Firstly, some of the risk factors for poor language development and emotional and behavioural problems are overlapping, such as social disadvantage (Horwitz et al., 2003; Olak et al., 2009; Singh & Ghandour, 2012). Secondly, language problems themselves may contribute to social and psychological difficulties that increase the risk of emotional and behaviour problems. Specifically, language problems may lead children to experience social isolation, reducing opportunities for acquiring good social skills and increasing the risk of poor self-esteem and poor emotional outcomes (Craig, 1993; Redmound & Rice, 1998; Wadman, Durkin, & Conti-Ramsden, 2008). Children with language problems are also at increased risk of being bullied (Redmond, 2011), and of having poorer emotion regulation (Fujiki, Brinton & Clarke, 2002). Finally, and of relevance to an array of different professions, when their language problems are not recognised, the behaviours of children and young people with DLD may be interpreted by the adults in their environment in a way that increases the likelihood of poor outcomes. In the context of forensic interviewing, Snow and Powell (2012) argue that the presentation of language problems in young offenders may lead professionals to assume that the young person is rude, or incoherent with their account of events (and therefore likely guilty). One account given by a young person in prison stated that when asked by a judge if he was remorseful of his crime, he said no: he had never heard the word “remorseful” before, and had no idea what it meant (Talbot, 2007). If such an experience is representative of young people with communication disorders’ interactions with the criminal justice system, it is perhaps not surprising that the rate of language problems is so high in young offender institutions. Extrapolating this to the headteacher’s office or the psychiatrist’s chair, we may predict that children with DLD are similarly judged as being uncooperative, unapologetic or reticent. It would be naïve to assume that untrained professionals will readily detect language problems in their cohorts. Rather, language impairments will not always be obvious to people interacting with a person with DLD; adults have a tendency to assume that children understand more of what is being said to them than is actually the case (Sattler, Feldman, & Bohanan, 1985), and children may engage in masking behaviours that cover their language problems (Evans & Macwhinney, 1999). Indeed, teachers have quite poor sensitivity and specificity to children’s oral language impairments (Antoniazzi, Snow & Dickson-Swift, 2010). Even in settings where we might expect educational staff to have a higher level of knowledge regarding language problems, this is not necessarily the case: in a special school for children with emotional and behavioural difficulties in which the prevalence of language impairment was 74%, less than half of these children had been identified as impaired (Stringer & Lozano, 2007). Speech problems may be the most detectable issue, but children with pure speech problems actually do not show adverse outcomes, compared to typical children (Johnson et al., 2010). Possibly this is because speech problems do not affect children’s social and emotional development in the same way that a language problem does. Alternatively, perhaps a child with a speech problem is far more likely to be identified and supported than a child who has a language impairment but whose speech does not sound unusual. What happens to these children and young people if their language problems are not recognised? The increased rates of language impairment in children facing exclusion from school and in the criminal justice system paint a gloomy picture. DLD is considered a lifelong condition, and while children’s language skills may improve, they require input from specialists to help them acquire skills and strategies to compensate for their language problems (Perkins, 2001). Clearly there are many children who finish schooling and enter services aiming to remediate mental health problems or criminal behaviours without their language problems having been detected. It is therefore important that awareness of DLD is sufficient in professions that are very likely to interact with children with DLD, including mental health and forensic professionals.

Acknowledgements

Geoff Bird was supported by the Baily Thomas Charitable Trust.

References

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Keywords: developmental language disorder (DLD), Language, vulnerable population group, Mental Health, Policy & disabilities

Conference: 4th International Conference on Educational Neuroscience, Abu Dhabi, United Arab Emirates, 10 Mar - 11 Mar, 2019.

Presentation Type: Oral Presentation (invited speakers only)

Topic: Educational Neuroscience

Citation: Hobson HM and Bird G (2019). High rates of language impairment in vulnerable populations: the case for improving cross-sector awareness of Developmental Language Disorder.. Conference Abstract: 4th International Conference on Educational Neuroscience. doi: 10.3389/conf.fnhum.2019.229.00002

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Received: 08 Feb 2019; Published Online: 27 Sep 2019.

* Correspondence: Dr. Hannah M Hobson, University of Greenwich, Greenwich, London, SE10 9LS, United Kingdom, H.Hobson@greenwich.ac.uk