This review article examines the long-term implications of specific language impairment (SLI), emphasizing the significance of assessment procedures, reading skills, and communicative competence for affected individuals. It highlights the variability in terminology and assessment strategies across different countries, particularly in the Czech Republic, where the term 'developmental dysphasia' is often used instead of SLI. The authors argue for a unified approach to assessment that combines psychometric and clinical strategies to better support SLI children and their families.
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Specific Language
This review article examines the long-term implications of specific language impairment (SLI), emphasizing the significance of assessment procedures, reading skills, and communicative competence for affected individuals. It highlights the variability in terminology and assessment strategies across different countries, particularly in the Czech Republic, where the term 'developmental dysphasia' is often used instead of SLI. The authors argue for a unified approach to assessment that combines psychometric and clinical strategies to better support SLI children and their families.
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health psychology report · volume 5(4), 7 Eva Richterová
review article Gabriela Seidlová Málková
Specific language impairment in the long-term
perspective – the importance of assessment procedures, reading skills, and communicative competence The purpose of this study is to provide a review of the lit- for their social life. The review draws on international re- erature regarding the treatment of specific language im- search mainly; however, the paper also aims to show how pairment (SLI) in the long-term perspective. We develop the three target issues are represented in the Czech re- the paper along the three issues we consider to be of the search related literature. most importance in relation to counseling practice with SLI children and young people: the importance of assess- key words ment procedures of SLI, the importance of reading skills in specific language impairment; assessment procedures; the lives of SLI children and adults, and the importance of reading skills; communicative and social competence the quality of communication competence of SLI people
organization – Faculty of Education, Charles University, Prague, Czech Republic
authors’ contributions – A: Study design · B: Data collection · C: Statistical analysis · D: Data interpretation · E: Manuscript preparation · F: Literature search · G: Funds collection corresponding author – Eva Richterová, Faculty of Education, Charles University, Prague, Czech Republic, e-mail: erichterova@gmail.com to cite this article – Richterová, E., & Seidlová Málková, G. (2017). Specific language impairment in the long-term perspective — the importance of assessment procedures, reading skills, and communicative competence. Health Psychology Report, 5(4), 273–284. doi: https://doi.org/10.5114/hpr.2017.69660 received 29.12.2016 · reviewed 11.04.2017 · accepted 05.05.2017 · published 25.08.2017 Background ers). The use of the term “specific language impair- ment” (SLI) is now widely accepted in the English Specific language impairment (SLI) is a serious dis- speaking literature and professional communities order of language development affecting the lives of (Reilly et al., 2014), and recent discussions relate in- thousands of people around the world. Early diag- stead to the specifications of the diagnostic criteria nosis and intervention are considered to be of cru- of SLI (see for example Webster & Shavell, 2004). It cial importance for the future development of a child should be however mentioned that the discussion with specific language impairment. For a consider- around the term “specific language impairment” has able number of children, however, SLI remains unde- recently become a serious issue again (especially in tected throughout the preschool age (Bishop & Mc- the International Journal of Language and Communi- Eva Richterová, Donald, 2009). Even when recognized, diagnosed, and cation Disorders, 49), after the publication of DSM-5 Gabriela Seidlová treated early, such as at the preschool age, the impact (APA, 2013), where the term “specific language im- Málková on individuals’ lives can still remain significant. We pairment” was not used. However, in contrast to the know that negative impacts of SLI overlap the area of international research related community, the use of language development; SLI is considered to be a gen- the term “specific language impairment” is not con- eral risk factor for literacy development (Durkin sistent in European countries, reflecting the national & Conti-Ramsden, 2007; Isoaho, Kaupilla, & Launon- policy in education and the development of the leg- en, 2016), and difficulties in interpersonal communi- islation in various educational systems. For exam- cation affect interpersonal relationships and can very ple, this is the case in the Czech Republic, where the often result in emotional troubles (Macharey & von term “developmental dysphasia” is used frequently Suchodoletz, 2008; Puglisi, Cáceres-Assenҫo, Noguei- and equally to the phrase “specific language impair- ra, & Befi-Lopes, 2016). ment” (e.g. Smolík in Seidlová Málková & Smolík, Thinking of SLI in the long-term perspective thus 2014; Tomická, 2012; Vávrů, 2010). Kucharská (2014) possibly relates to various issues. This paper aims explains this situation by the influence of the termi- to review the most important results and questions nology used in the current Czech educational legis- raised in literature around the quality of life and lation (§16 Act. No. 561/2004 on preschool, primary, well-being of SLI individuals. We structure the text secondary, higher and other education). We believe by addressing the three issues we consider to be of that the problematic aspect of the use of the term the most importance in relation to counseling prac- “developmental dysphasia” (in contrast to the SLI no- tice with SLI children and young people. These are: tion) is that it may particularly emphasize the devel- 1) assessment criteria and procedures of SLI and its opmental aspect of language impairment, and may variability, 2) the importance of reading skills in the also be associated with organic brain injuries among lives of SLI people, and 3) the quality of communica- some people, including those who are involved in the tion competence of SLI people and its impact on their educational system. social life. Each chapter of this text touches on one Even though the terminology for SLI is not used of the issues listed. Our intention is to also provide in the Czech Republic consistently (and we believe comments on these issues from the perspective of the also in some other European countries), Czech re- Czech counseling and speech therapy practice. The search and academic papers accept the definition of final part of our paper provides thoughts and ideas SLI agreed in the international community (Durdilová which are relevant in relation to counseling practice & Klenková, 2014; Kucharská, 2014; Richterová & Se- with SLI children and young people, the practice that idlová Málková, 2016; Seidlová Málková & Smolík takes into consideration the long-term relevance of 2014; and others). Together with interested practi- SLI children difficulties. tioners (speech therapists or school psychologists), ac- ademics and researchers all support progress towards greater acceptance of the term “specific language im- Issues in Specific language pairment” in the field of educational practice. There- impairment assessment fore, we use the term “specific language impairment” procedures (SLI) here to refer not only to international literature, but also to the Czech and Slovak research papers The term ‘specific language impairment’ is defined as (where the term “developmental dysphasia” is used). a form of developmental language impairment with The inconsistency in terminology relating to SLI an estimated overall prevalence rate of 7.4% (Tomblin strongly influences the educational systems, where et al., 1997). The cognitive skills of the children with SLI children act and are treated, and of course it has SLI are within the normal limits where there is no an impact on the assessment procedures used for the identifiable reason for the language impairment – purpose of SLI differential assessment procedures. such as mental retardation, neurological damage, The assessment procedures and strategies relevant hearing deficits, or environmental deprivation (Bish- for SLI are strongly influenced by the SLI symptom- op, 1992; Williams, Larkin, & Blaggan, 2013; and oth- atology. It is rather broad, affecting grammatical, lexi-
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cal, and phonological aspects of language processing. or assessment with the child’s parents. Standardized Individuals with SLI are also considered to be quite questionnaires for parents or teachers to assess the diverse rather than a homogenous group (Hulme child’s communication and language abilities are used & Snowling, 2009; Isoaho et al., 2015; Leonard, 2000), for this purpose in English speaking countries – for showing variable clinical symptoms according to the example Communication Checklist-CCC or CCC-2 type and number of language domains affected and (Norbury, Nash, Baird, & Bishop, 2004). the scale of these difficulties. Symptoms of SLI also Another important aspect relating to the assess- tend to change during the development of suffer- ment procedures of SLI is the actual manifestation of ers. Since the terminology is not unified and clinical speech delay or language difficulties. This is often the symptoms of SLI can vary considerably, precise di- first reason why parents bring their child to profes- agnostics of SLI are difficult to describe. No wonder sionals, usually a speech therapist, and this incites the A review then that SLI related literature struggles to agree on process of SLI diagnosis and treatment. However, lan- of long-term a unified assessment or differential assessment pro- guage difficulties are not always noticeable in a child, impacts cedure for SLI. From the very broad perspective, as- and therefore it is not possible to start effective in- of specific sessment procedures used in relation to SLI reflect tervention early. Some studies warn that not every language two different approaches (strategies) to understand child in speech therapy fulfils the psychometric cri- impairment and treat SLI: psychometric and clinical strategies. teria of SLI (Bishop & Hayiou-Thomas, 2008). Keegs- Psychometric strategies are rooted in the use of tra, Knijff, Post, and Goorhuis-Brouwer (2007) proved standardized assessment tools and batteries for the that from 240 preschool children treated at a speech detailed assessment of speech and language skills of therapy centre in the Netherlands, 35% had normal the child. Clinical strategies invest more into detailed language related abilities development (tested in lan- and individualized assessment of speech, hearing, guage production and understanding). Aram, Morris, and language and tend to involve more profession- and Hall (1993) examined 252 preschool children (age als – usually a speech therapist, psychologist, and 3 to 6) and compared the reliability and overlapping phoniatrician. As both strategies can contribute to of clinical diagnosis of SLI and diagnosis of SLI for the best diagnostics possible, they are, ideally, to be research purposes. The correspondence between combined. The differences between results from psy- clinical assessment results and the results based on chometric and clinical strategies in the assessment psychometric procedures and tests (e.g. nonverbal in- of SLI are frequently discussed in the literature, and telligence score, difference between the chronological they should be considered to have high importance. and language level related age of the child, language Tomblin et al. (1997) found that only 29% of children test score) varies considerably – between 20 and diagnosed with SLI on the basis of psychometric diag- 71%. Aram, Morris, and Hall’s study (ibid.) indicates nostics had already been diagnosed with a language that the conclusions from clinical and psychometric development disorder. On the other hand, Bishop and assessment criteria of SLI differ vastly. Clinical ap- Hayiou-Thomas (2008) warn that the exclusive use of proaches may be misleading, particularly in environ- psychometric tests can lead to false positivity, where ments with a higher risk of language impairment, for the results fulfilling the condition for SLI are actually example in families where some degree of speech or a consequence of worsened attention or motivation. language impairment is already present (Bartlett et A different study found that psychometric criteria can al., 2002; Bishop, 2006; Gopnik & Crago, 1991). be rather restrictive and less sensitive to language im- From the long-term perspective, it seems to be pairment than the clinical assessment of a child in its crucial for SLI children and their families to search natural environment (Dunn, Flax, Sliwinski, & Aram for those services in the educational system where 1996), claiming that children diagnosed with SLI on both clinical and psychometric strategies are applied. the basis of clinical examination make more mistakes Reliable screening methods should be available to in spontaneous speech in comparison with children different professionals (speech therapists, psycholo- with normal development, regardless of whether gists, special education teachers and teachers), and they meet the psychometric criteria for SLI or not. used for SLI risk screening. Positive results from this Child observation in everyday situations, most cru- screening should be assessed in detail for each aspect cially, can identify symptoms which might be missed of language and speech development. by psychometric tests. A comparative study of both The important preconditions for this approach, strategies conducted by Bishop and McDonald (2009) however, are: 1) an agreement at the level of defini- says that performance in language tests predicts the tion and diagnostic criteria of SLI (as suggested by risk of academic failure reliably (the most reliable in Leonard [2000]), and 2) production and publication of this respect are short-term verbal memory span tests). a quality set of psychometric tools for complex lan- However, the authors discourage the general over-re- guage assessment. It should be noted that some Euro- liance on the psychometric tests and advise profes- pean countries may have difficulty in relation to these sionals to combine the data obtained from psychomet- preconditions. That is the case of the Czech Republic. ric procedures with reports from detailed interviews First, as already mentioned, the terminology related
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to SLI in both the professional and non-professional tice, especially the branch associated with school or- communities is not unified. Secondly, the diagnostic ganizations, tends to focus mainly on screening and criteria and procedures process for SLI screening and assessing the child’s speech development, especially assessment is not unified and centralized. Thirdly, articulation. Careful descriptions of the structure of clinical strategies are vastly dominant in the Czech the child’s language abilities (phonological, lexical Republic, and standardized psychometric tools for and grammatical) are far less common. Therefore, language assessment are not available. The screen- an important task with respect to the long-term per- ing relevant for SLI in the Czech educational system spectives of SLI children in the educational system relates to speech development and its risks. It is usu- is to raise awareness among non-professionals and ally provided by teachers in kindergartens, and also professionals alike that SLI should not be understood Eva Richterová, sometimes by a speech therapist in schools. A speech as a “mere” speech impairment which belongs solely Gabriela Seidlová therapist is also typically the first one contacted by to the speech therapy center. Málková parents because of their child’s persistent speech and language difficulties. Speech therapists may coop- erate with teachers, a psychologist, a phoniatrician, Issues on the importance a neurologist, or a pediatric specialist if needed. How- of reading skills ever, speech difficulties are not necessarily evident in every case of SLI (Kucharská, 2014; Tomblin et al., Children with SLI very often face serious troubles 1997), so some children with SLI are not identified at in literacy acquisition, and as a result of that also in the preschool age, and these may only be recognized education and vocational training in general. Cur- later when entering primary school. At the time of rent research and academic papers understand SLI as primary school entry awareness of the language and a risk factor in literacy development (Cutting & Scar- speech skills is typically raised in schools when re- borough, 2006; Gillon, 2000; Gopnik, 1990; Hulme lating to the literacy and school readiness concept & Snowling, 2009; Kucharská, 2014; Perfetti, 2007; in the Czech educational system. There are no clear Perfetti & Lesgold, 1977; Smolík & Seidlová Málková, and shared framework guidelines for Czech speech 2014; Stanovich, 1985); however, at the same time therapists (psychologist, special education teachers, difficulties in reading literacy acquisition are not de- or professionals in the educational system for meet- scribed as the only consequence of SLI (Conti-Rams- ing SLI) with respect to the SLI assessment criteria. den, Mok, Pickles, & Durkin, 2013; Leonard, 2000; Professional organizations provide training and ed- Mikulajová & Rafajdusová, 1993). Children with SLI ucation in courses targeting SLI issues, and method- are typically reported to be at a higher risk of diffi- ical manuals for diagnostic processes are emerging culties in reading literacy acquisition in comparison (Fleischmannová, 2012), but the system (professional to control groups of the same age. The more severe organizations, respectively) lacks connections and language difficulties simply imply a more serious agreement. Generally speaking, clinical approaches danger of reading difficulties. Catts, Fey, Tomblin, are dominant, and at the same time they vary accord- and Zhang (2002) specify that children with a history ing to the background of the professional criteria of speech-language difficulties at preschool age are meeting SLI. We think that a core issue with respect at four to five times greater risk of the occurrence to the assessment of SLI in the Czech Republic is of reading difficulties than non-impaired children. the lack of quality psychometric tools required for Bishop and Adams (1990) assessed 83 children with thorough SLI assessment. Large assessment batteries language development difficulties for their language of language skills are available around Europe, and and literacy skills: first at the age of 4 and later when especially in English speaking countries, but not in aged 8 and a half. Children whose difficulties were the Czech Republic. It should be noted that in recent resolved at 5.5 years of age had no difficulties in liter- years the rate of introduction and publishing of qual- acy acquisition, while children with persisting verbal ity standardized language assessment tools has been difficulties proved to have poor reading performance. growing (for example Durdilová, & Klenková, 2014; Kucharská (2014), in a study with Czech preschool Seidlová Málková & Smolík, 2014; Smolík, Turková, children, concluded that 65% of SLI children assessed Marušicová, & Malechová, in press), but the current for the first time at the age of 5.5 should be consid- situation should still be considered insufficient. Since ered to be at risk of literacy acquisition issues. Scar- psychometric tests are neither profitable nor ap- borough & Fowler (1993) reported that generally 40 preciated as a valuable research output in academic to 75% of preschool children manifesting language or performance evaluation, standardized tools for (not speech difficulties are at risk of difficulties with read- only) language and communication skills assessment ing skills development. The risk of difficulties in lit- are not supported. An additional issue influencing eracy acquisition rises significantly with the number SLI treatment in Czech counseling practice is the cat- of affected language domains (as reported by Bishop, egorization of SLI among impairments in speech and 2001). According to Bishop (2001), the prevalence of communication skills. Czech speech therapy prac- reading difficulties for children with issues in only
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one language domain is 29%, for children with diffi- & Adams, 1990; Ricketts, 2011). The quality of read- culties in two language domains the accompanying ing comprehension is very much related to the gram- reading difficulties are apparent in 72% of cases, and matical language domain (resp. morphology and children with three or more impaired language do- syntax). Morpho-syntactic language skills level are mains show reading difficulties in 89% of cases. frequently discussed in children with SLI (Gopnik, Ricketts (2011), like Chen and Vellutino (1997), as- 1990; Leonard, 2000; Rice, 2000; and others), and are sumed that difficulties in initial reading comprehen- very often considered to be one of the core indicators sion are related to weak word recognition processes, of this impairment. The role of memory (e.g. word re- while later reading difficulties are more often the re- calling or word substitution, especially in words with sult of language skills failure (as the general reading similar meaning) is also discussed in relation to the level is increasingly more and more determined by reading skills of SLI children (Coady & Aslin, 2003; A review language skills). Therefore, the reading profiles of SLI Hulme & Snowling, 2009). Zecker and Zinner (1987) of long-term children may significantly vary according to the type point out that children with SLI can register the same impacts of language domains affected and according to the amount of semantic information as their peers, but of specific size of the deficits in the affected language domains. they suffer from worsened accessibility to this in- language A longitudinal study by Catts et al. (2002) observed formation, a more difficult process of remembering, impairment the development of reading skills in children with and generally slower recall of information from their language impairment (both specific and nonspecific) working memory. which were previously assessed in the epidemiological As the large scale studies cited above confirmed, study of preschool children conducted by Tomblin et 30-50% of all SLI children face both decoding and al. (1997). Children were again assessed on language, reading comprehension difficulties. From 15% to 25% reading in the second and fourth grade, and nonver- face reading difficulties only at the level of reading bal cognitive skills in the second grade. Approximately comprehension, and approximately 2-10% have trou- one third of the children with language impairment bles only with initial reading comprehension. This had difficulties in both aspects of reading – decoding means that almost two thirds of all SLI children may and reading comprehension – while only a small per- face some long-lasting reading issues throughout centage of children had difficulties with decoding alone their educational career. It is important to note that (10% in the second grade, 12% in the fourth grade). insufficient reading comprehension is especially im- The children who no longer met the criteria for lan- portant from the long-term perspective; it has a huge guage impairment had better reading performance than impact in the area of theoretical knowledge acquisi- children with persistent language difficulties, but still tion. If the reader does not understand the meaning of worse than non-impaired control children. Conti-Rams- the text, the possibility to profit from it is very limited. den, Botting and Durkin (2008) conducted a study with The negative impact of the low level reading skills 16-year-old adolescents with a history of SLI to explore of SLI youngsters on their educational outputs was their reading profiles. Only 24% had reading skills at confirmed in some previous studies. Cain and Oakh- a good level, while the rest of the sample had some ill (2006) found that children with a low level of read- difficulties. The most commonly (47%) impaired areas ing comprehension at the age of 8 showed a signifi- were reading skills (both reading accuracy and reading cantly lower level of general education outcomes at comprehension). Twenty-seven percent had difficulties age 11 (compared with their peers with normal read- solely with reading comprehension, while a mere 2% ing comprehension). Dockrell, Lindsay, and Palikara had difficulties with text decoding only. (2011) report similar results for 16-year-old adoles- The quality of the decoding process and early cents with a history of SLI. stages of reading of SLI children are often discussed SLI is widely considered as a risk factor for lit- in relation to the phonological skills and processes eracy development, and children often experience (Gillon, 2000; Hulme & Snowling, 2009; Kucharská, difficulties with broader academic abilities (e.g. Bish- 2014; Stanovich, 1985). However, the role of phono- op & Snowling, 2004; Stothard, Snowling, Bishop, logical skills in SLI children’s reading profiles is not Chaipchase, & Kaplan, 1998), and it also impacts ed- described consistently. Kelso, Fletcher, and Lee (2007) ucation in adulthood as much as at school age. This point to the significant variability of the phonological serious implication of SLI has also been documented skills in SLI children manifesting insufficient reading in a small number of studies focusing on literacy out- comprehension. Some SLI children have no impaired comes of SLI adults. For example, Whitehouse, Line, phonological skills and do not face decoding difficul- Watt, and Bishop (2009) worked with individuals ties during their early school years (Nation, Clarke, who had participated throughout their childhood in Marshall, & Durand, 2004). More often, the reading any of the six research projects conducted by Bish- difficulties of SLI children occur at around the time op and her colleagues between 1989 and 2004. The when reading comprehension becomes an important results of this study show that some deficiencies in target, and things other than phonological language language and literacy skills remain present in the domains start to influence their reading skills (Bishop majority of SLI people into adulthood, especially
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deficits in speech production, receptive grammar, dren were also described by Richterová and Seidlová verbal short-term memory, and phoneme awareness. Málková (2016). The authors compared the reading Leonard (2000) confirmed these results. Although profiles of SLI children from the first and the fourth these studies may suggest that SLI impacts job op- grade of primary school with the reading profiles of portunities, longitudinal studies focused on the rela- age controls with typical language development. The tionship between language problems and academic differences between the observed first grade groups or professional attainment are relatively few (Dock- were apparent, but not statistically significant, in rell et al., 2011). both aspects of reading (decoding and comprehen- It is therefore important to point out how neces- sion), and were statistically significant for the mea- sary it is to carefully explore the language and cog- sure of listening comprehension. Fourth grade SLI Eva Richterová, nitive skills of SLI individuals in relation to their children’s reading performance was lower than in Gabriela Seidlová reading skills. The mutual relationship of these skills their normally developing peers, significantly lower Málková is a complicated matter of course, but it is an import- for listening comprehension and decoding, measured ant starting point for any further intervention. The by the One minute reading and Non-word reading effectiveness of a combined support system related tasks from the Caravolas & Volín (2005) test battery, to both language and reading difficulties in children and Listening comprehension tasks from Kucharská with SLI is evident from a number of studies (Acos- and Mrázková (in Kucharská et al., 2014). It should ta Rodriguez, Ramírez Santana, del Valle Hernández, be noted here that research on SLI youngsters, ado- & de Castro Bermúdez, 2016; Bishop & Edmundson, lescents, or adults in educational contexts does not 1987; Catts et al., 2002). exist in the Czech research literature. We believe that The research on literacy related difficulties of SLI developmental studies on young people with SLI are children in the Czech Republic does not have any especially needed for the purpose of career related tradition, and it could even be said that it has been counseling. neglected for a long time. Kucharská (2014) explains that this could be due to the fact that practitioners working with SLI children in the Czech Republic Issues in communicative consider the speech and language problems of SLI competence and social children as being dominant and pay attention to the development intervention at this level almost exclusively. Litera- cy difficulties of SLI children may therefore be un- The third important issue that we believe relates derstood as appearing incidentally. The research on strongly to the SLI persons’ long-term perspective development of reading skills in Czech SLI children of well-being is the problem of the quality of their is therefore not much supported, and in fact to the communicative competence. Poor language skills present day it is represented by only a few stud- play an important role in SLI people’s social devel- ies. Between 2009 and 2014 Kucharská published opment (Botting & Conti Ramsden, 2008) and may two related studies about the development of chil- negatively influence their self-esteem, emotional dren at risk of difficulties in literacy development health, and quality of life in general. Research papers (Jagerčíková & Kucharská, 2012; Kucharská, 2014). frequently mention that SLI children and adults face She followed the development of language and cog- difficulties in understanding the context of commu- nitive skills in children with typical development, nication, expressions of personal thoughts, wishes, children with a familiar risk of dyslexia, and children needs, and emotions. Research shows that children with SLI. Children were tested at six consecutive with SLI have a lower degree of social competence time points: from preschool age until the third year (Lindsay & Dockrell, 2000; Puglisi et al., 2016), es- of primary school. Among others, children with SLI pecially at the level of prosocial behavior and social were the group with the most significant occurrence cognition (Bakopoulou & Dockrell, 2016; Hart, Fujiki, of ‘literacy disorders’. In the first grade of primary Brinton, & Hart, 2004). St Clair, Pickles, Durkin, and school the SLI children were performing at a lower Conti-Ramsden (2011) reported serious difficulties in level in decoding, reading comprehension, and spell- peer relationships among as many as 40% of 16-year- ing when compared to other included subgroups. The old adolescents with a history of SLI. Compared to differences between observed subgroups were not their peers, children with SLI would be more likely statistically significant. However, the differences in to be less active in social relationships, more vulner- particular literacy skills became greater and statis- able to conflict, and they would more likely exhibit tically significant throughout the third grade of pri- problematic behavior in general. It is also observed mary school. For example, decoding of SLI children that these difficulties do not disappear with age, but was better than that of children with a familiar risk instead increase. of dyslexia, but the reading comprehension remained The troubles SLI people face in their social rela- the worst in the group of SLI children. The develop- tionships could be understood by taking into con- ment and the structure of reading skills in SLI chil- sideration the importance of social background for
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the SLI persons’ well-being. As Sigelman and Rider difficulties were present (reported by parents or chil- (2009) explain, so-called proximity in early years, dren’s caregivers) in roughly 50% of SLI children, and given by neighborhood or kindergarten relation- these involved both externalizing difficulties (such ships, is understood as the key factor for friendship as aggression and rule breaking) and internalizing relationship development. Later on, more specific difficulties (such as anxiety, depression and somatic factors such as shared interests or similar character symptoms). The proportion of SLI children with low- traits become more important for peer relationships, er social competence (such as achieving satisfactory while adolescent years bring a need for intimacy, academic skills, and engaging in activities such as sharing, self-esteem, and personal identity consoli- sports and hobbies) was even higher – around 95%. dation in the context of the peer relationships. We The negative impact of SLI on social life is of could expect that all of the important factors of social course a problem for relatives and family members A review development mentioned could be presumably affect- of SLI people (for example parents of SLI children or of long-term ed by the language expression and reception difficul- adults). Macharey and von Suchodoletz (2008) exam- impacts ties of SLI people. ined perceived stigmatization by parents of SLI chil- of specific However, it may be difficult to identify causality dren as a consequence of the language difficulties in language here. Durkin and Conti-Ramsden (2007) brought an their child. The study focused on stigmatization by impairment interesting insight into this problem. In their study other children, other adults, and family members. of the quality of life in 16-year-old SLI adolescents Approximately 50% of the parents stated that their (participants in the Manchester Language Study) and children had experienced negative labeling, restrict- their age controls with typical language develop- ed contacts, and social rejection, mostly by other ment, the SLI group reported more behavioral diffi- children. Approximately 20% of parents also felt culties, emotional symptoms, and peer relationship lower acceptance of their child within their family. difficulties than their age controls. The biggest dif- Around 33% of parents experienced stigmatization ference between the groups was found in the area of of themselves related to the developmental abnor- peer relationship (25% vs. 2.4%). Another important malities of their children, manifested mostly in the result of the study was that participants with a low- form of disparaging remarks, avoidance of contact, er level of receptive language skills reported behav- or beliefs that they are responsible for their child’s ioral and emotional difficulties more frequently. The developmental problems. The impact of this stigma- authors also aimed to identify predictors of friend- tization is serious – parents frequently tend to play ships and the quality of peer relationships. The re- down their child’s problems, or they reduced their sults suggested a mutual connection of the quality of amount of social contact. peer relationships with both expressive and receptive Existing research papers clearly show that SLI language skills and reading skills. However, the au- children and adults face (as a result of their poor lan- thors pointed out that language skills were not the guage skills) a lower level of social competence in most significant predictors of the quality of friend- comparison to their peers. This of course has serious ship relationships; actually their influence was quite consequences for their social lives and relationships. marginal. The strongest predictors were the presence Research also indicates that these difficulties are not of a difficult behavior (e.g. conflicts, situationally-in- just a short-term issue. Lower communicative com- appropriate responses) and the presence of prosocial petence may be a consequence of the language de- behavior (e.g. cooperation, active conversational in- velopment difficulties of SLI children, and therefore teraction) of individuals with SLI. This study brings should be considered as an important aspect of inter- another interesting finding. As for the subjective ventional procedures provided for SLI people, espe- perception of friendship quality, there was consider- cially children. This of course represents a challenge able within-group heterogeneity in SLI adolescents. to researchers, practitioners, and for the educational Many of them (60%) perceived the quality of their and counseling systems the most. It is clear that there friendships as good. According to the results of this is a need for supportive practices at the level of com- study, the authors suggest that the low quality of re- municative and social competence across the lifespan lationships may not simply be a direct consequence of SLI individuals. of language problems, but it is an additional difficulty Czech research on SLI has traditionally been present in SLI which becomes more evident during carried out by speech therapists and has focused adolescence. Another study assessing the relation- predominantly on clinically relevant assessment ship between language skills, behavioral problems, procedures (for instance on the application of aug- and the level of social competence was conducted by mentative and alternative communication approach- Puglisi et al. (2016) with Brazilian children between es in therapy – Bočková, 2007), or on speech therapy the ages of 6 and 11 years. Children with SLI in this assessment procedures (Mlynářová, 2007; Tomická, study reported more behavioral problems and a low- 2012). Recently, there has been a growing num- er level of social competence than their peers with ber of special education oriented studies (Bočková, typical development of language skills. Behavioral 2009; Kutálková, 2002) and of texts rooted in psycho-
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linguistics (Kucharská, 2014; Smolík, 2009; Smolík age) seems to be an obvious target for counseling and & Seidlová Málková, 2014). However, research on speech therapy practice. This should specifically in- the relationship of communicative competencies of clude strategies to identify those SLI children who do SLI children and their social life throughout their life not face speech difficulties at preschool age, and who span does not yet exist in the Czech research litera- therefore are not typically identified before they enter ture. We believe that this is a promising and import- primary school and face the need to become literate. ant topic for future research in both the Czech Re- Studies on the importance of reading and com- public and in other European countries (as it is clear munication competencies in social relationships for that research on this topic comes mainly from the SLI people’s lives seem to reveal a clear picture. SLI USA and the UK). children and their families face many difficulties in Eva Richterová, their everyday lives. One example of this can be tak- Gabriela Seidlová en from the study by Conti-Ramsden et al. (2008), Málková Conclusion and suggestions cited in the previous text, where the impact of SLI for the prevention of life-long on literacy, educational achievement, friendships, disadvantages for Specific and emotional health was monitored. Only 8% out of language impairment people 139 16‑year-old adolescents in this study stated that they did not feel any difficulties in any of the areas The purpose of this study was to discuss in detail is- concerned, and the most severe impact of SLI was sues related to the quality of life and well-being of related to education and literacy. This implies that SLI people, especially children and youngsters. We SLI children and youngsters have specific needs that decided to aim our review at three important issues should be respected in the educational and counsel- which hugely affect the education and the working ing process. SLI should be included among learning career of SLI people: assessment, reading, and social disorders, and its understanding as a specific learn- communication competencies. Current research re- ing disability should be encouraged – this is of huge lated literature now contains quite a lot of knowledge importance, particularly in Czech Republic educa- about SLI and its consequences when thinking in the tional practice. A number of teachers have well-pre- life-time perspective. It is clear that SLI must be per- pared methods for reading development, often using ceived as a concern, not solely in the childhood and strategies to support reading comprehension skills pubescent development period, but as a language im- (monitoring and explaining, asking text-related pairment with a distinct influence on a person’s life questions, visualization, summarization, etc.) (Arm- and the lives of his or her closest relatives. buster, Lehr, Osborn, Adler, & National Institute for Our review identifies the importance of the agree- Literacy, 2009). But very often these strategies are not ment and unanimity at the level of diagnostic crite- related to intervention in the speech and language ria of SLI (including its functional definition) within development of a particular child. Remediation of the educational/counseling systems of a particular reading skills should be parallel and connected with country. The heterogeneity of this disorder, however, the intervention in language skills. The positive in- makes this a very difficult task. On the other hand, fluence of such strategies has already been proved the identification of SLI at preschool age seems to be in children with SLI (Acosta Rodriguez et al., 2016; very functional when concentrating on a complex Buil-Legaz, Aguilar-Mediavilla, & Rodriguez-Fer- assessment of language skills and communicative reiro, 2016; see Hulme & Snowling, 2011, for further competencies. It implies the need to work on the notes). Furthermore, there is a need to act on inter- production of standardized assessment tools for SLI disciplinary rooted practice for SLI children. It seems screening and diagnostic procedures and the need to be clear that speech therapists, psychologists, and to effectively combine both clinical and psychomet- teachers should cooperate to provide not only sys- ric strategies when working with children at risk of tematic support at the level of language (and litera- language development issues. This applies especial- cy) development, but also at the level of continuous ly for the Czech Republic, with largely only clini- support or development of the communicative skills cal assessment procedures prevailing for the most and social competencies of SLI people. Our review part. Strategies and steps for strengthening cooper- clearly shows that insufficient language skills very ation between researchers and practitioners for the often negatively influence the development of read- purpose of constructing and standardizing quality ing skills, and this could lead to further difficulties language skill assessment batteries are of high im- in other literacy aspects (functional, financial, and portance here. It seems to be clear that various neg- digital literacy), and from a life-time perspective SLI ative consequences of SLI could be reduced by the people may lack options in both further education early assessment and early and effective intervention and career. Literacy related difficulties and troubles strategies implemented within the educational sys- in educational contexts of SLI people clearly do not tem. The effort to identify children at risk of language decline with age, and this should be understood to be difficulties as soon as possible (optimally at preschool an alarming point.
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Finally, counseling and clinical practice should Bishop, D. V. M., & Edmundson, A. (1987). Lan- rely on and work in relation to research teams as this guage-Impaired 4-Year-Olds Distinguishing enables further development at the level of quality Transient from Persistent Impairment. Journal of services provided for SLI people, in particular as ac- speech and hearing disorders, 52, 156–173. tors in the educational system. We identified a lot of Bishop, D. V. M., & Hayiou-Thomas, M. E. (2008). space for further research for each of the issues we Heritability of specific language impairment de- specifically analyzed for the purpose of our review. pends on diagnostic criteria. Genes, Brain and Be- The most neglected area seems to be the research on havior, 7, 365–372. SLI youngsters’ and adults’ social lives, and of course Bishop, D. V. M., & McDonald, D. (2009). Identify- longitudinal studies of SLI people that would enable ing language impairment in children: combining us to find out more about the manifestations of SLI in language test scores with parental report. Inter- A review adolescence and adulthood. national Journal of Language & Communication of long-term Disorders, 44, 600–615. impacts Bishop, D. V. M., & Snowling, M. (2004). Develop- of specific References mental dyslexia and specific language impair- language ment: same or different? Psychological Bulletin, impairment Acosta Rodríguez, V. M., Ramírez Santana, G. M., del 130, 858–886. Valle Hernández, N., & de Castro Bermúdez, L. Bočková, B. (2007). Aplikace principů alternativní (2016). Intervention in reading processes in pupils a augmentativní komunikace v terapii vývojové with Specific Language Impairment (SLI). Psico- dysfázie [Application of principles of alternative thema, 28, 40–46. and compensatory communication in specific American Psychiatric Association (2013). 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