Introduction

The following exercise is a case study of a boy (‘DF’) with specific language impairment who was studied by Tompkins and Farrar (Reference Tompkins and Farrar2011). DF was recruited from a speech and hearing centre preschool programme in Florida which admitted children who qualified for language services. The case study is presented in five sections: primer on specific language impairment; client history and cognitive-linguistic profile; focus on narrative production; focus on maternal language in SLI; and impact and outcomes in SLI.

Primer on specific language impairment

Specific language impairment (SLI) is a specific developmental disorder. As its name suggests, the disorder is specific to language, with other domains of development (motor, cognitive, etc.) proceeding along normal lines. (SLI is to be distinguished from a pervasive developmental disorder such as autism spectrum disorder in which several domains of development are compromised.) Children with SLI have an impairment of language in the absence of conditions that are normally associated with language disorders. These conditions include hearing loss, intellectual disability, sensory impairments, neurological impairment and emotional disturbance. Notwithstanding the absence of these conditions, children with SLI present with a severe disorder of language which can persist into adulthood, and which has serious consequences for the academic achievement, and social and occupational functioning of affected individuals (Whitehouse et al., Reference Whitehouse, Watt, Line and Bishop2009a, Reference Whitehouse, Line, Watt and Bishop2009b).

The prevalence of SLI has been investigated in several studies. There has been considerable variation in the figures reported by investigators. Tomblin et al. (Reference Tomblin, Records, Buckwalter, Zhang, Smith and O'Brien1997) estimated the prevalence of SLI in a population of monolingual English-speaking kindergarten children in the United States to be 7.4%. A much lower prevalence figure of less than 1% was reported by Hannus et al. (Reference Hannus, Kauppila and Launonen2009) in a study of SLI in Finnish children aged 0 to 6 years. Reilly et al. (Reference Reilly, Wake, Ukoumunne, Bavin, Prior, Cini, Conway, Eadie and Bretherton2010) reported that 251 (17.2%) of 1,462 4-year-old Australian children met criteria for SLI. The prevalence of SLI is higher in boys than in girls and in certain special populations. Tomblin et al. reported the prevalence of SLI in the boys and girls in their study to be 8% and 6%, respectively. In a study of 147 pupils attending language resource units, Archibald and Gathercole (Reference Archibald and Gathercole2006) reported the prevalence of SLI to be 13%, with receptive–expressive SLI and expressive-only SLI accounting for 13% and 10% of the sample, respectively.

Language in SLI can be disrupted at several levels including phonology, morphology, syntax and semantics. Aguilar-Mediavilla et al. (Reference Aguilar-Mediavilla, Sanz-Torrent and Serra-Raventos2002) examined the phonology of 3-year-old children with SLI. They found that these children used more syllabic and non-syllabic cluster reduction and initial and final consonant deletions than age controls. Children with SLI also deleted medial consonants significantly more often than age controls and deleted unstressed syllables in initial position significantly more than control subjects. Grammatical morphology is an area of difficulty for children with SLI, with regular past tense –ed, regular third-person singular –s and copula/auxiliary ‘be’ forms used less frequently by these children than by control subjects. Complex syntax such as the comprehension and production of relative clauses and complement clauses is also impaired. (The reader is referred to Ellis Weismer (Reference Ellis Weismer and Cummings2014) for further discussion of grammatical morphology and complex syntax in SLI.) Lexical semantic deficits are also evident in SLI. Children with SLI produce more naming errors than normally developing children (McGregor et al., Reference McGregor, Newman, Reilly and Capone2002), and have weak receptive vocabulary as measured by word–picture matching (Laws et al., Reference Laws, Briscoe, Ang, Brown, Hermena and Kapikian2015). Pragmatic deficits have also been reported in SLI (see Cummings (Reference Cummings2009, Reference Cummings and Cummings2014a, Reference Cummings2014b) for discussion). When these deficits are severe or the predominant language deficit, children are diagnosed with a subtype of SLI called pragmatic language impairment.

Client history and cognitive-linguistic profile

Before DF was recruited to the study, his file was reviewed. DF came from an English-speaking, middle-class family. His mother had 16 years of education. DF had passed hearing screenings and had no previous medical conditions that might account for his language problems.

DF's language skills were assessed using the Structured Photographic Expressive Language Test 3 (SPELT-3; Dawson et al., Reference Dawson, Stout and Eyer2003). DF achieved a score of 72 on this assessment, which placed him below the age of four according to the SPELT age equivalency scores. DF's receptive vocabulary was assessed using the Peabody Picture Vocabulary Test – 3rd edn (PPVT-3; Dunn and Dunn, Reference Dunn and Dunn1997). His score on the PPVT-3 was in the normal range. The Leiter International Performance Scale-Revised (Roid et al., Reference Roid, Nellis, McLellan and McCallum2003) was used to assess DF's non-verbal cognitive ability. This assessment measures visualisation, reasoning, memory and attention. DF scored within normal limits on the Leiter-R.

Focus on narrative production

DF and his mother were recorded undertaking two narrative production tasks. During an autobiographical memory narrative task (narrative 1), DF's mother encouraged him to narrate events that had occurred during a family camping holiday. During a storybook narrative task (narrative 2), DF was encouraged to tell a story based on a wordless storybook Frog Goes to Dinner (Mayer, Reference Mayer1974). In this story, a boy and his family go to a fancy restaurant for dinner. The boy's mischievous pet frog goes along with them.

Focus on maternal language in SLI

Aside from providing information about DF's language skills, the narratives in unit 12.3 can also tell us about the ways in which maternal language may be modified to facilitate language development in children with SLI. Increasingly, investigators are examining maternal language use with a view to understanding the influence of maternal linguistic behaviours on the conversational participation of children with SLI. Majorano and Lavelli (Reference Majorano and Lavelli2015) examined 15 Italian-speaking children with SLI during shared book reading with their mothers. The informativeness of maternal utterances – coded on the basis of sophisticated word use – and use of scaffolding were analysed. Mothers of children with SLI produced a higher percentage of directly informative utterances with gestural scaffolding than did mothers of chronological age-matched children. Children's lexical development three months after the study was related to direct maternal informativeness in both groups of children, and to gestural scaffolding only in children with SLI. Barachetti and Lavelli (Reference Barachetti and Lavelli2011) examined repairs produced by mothers of children with SLI during shared book-reading conversation. Repairs were defined as any utterance that aimed to correct a child's problematic answer. Mothers of children with SLI produced significantly more high-supportive repairs than mothers of age-matched children. In children with SLI, supportive repairs significantly affected the occurrence of minimally acceptable answers, while non-supportive repairs affected significantly the occurrence of inadequate answers.

Some studies have failed to establish an effect of maternal language use on the responsiveness and participation of children with SLI. Rezzonico et al. (Reference Rezzonico, de Weck, Salazar Orvig, da Silva and Rahmati2014) examined the number and type of recasts used by mothers of French-speaking children with SLI during four different activities – joint reading, symbolic play, question-guessing game and clue-guessing game. Mothers of children with SLI provided more recasts than mothers of typically developing children. Moreover, these took the form of phonological recasts as opposed to lexical recasts which were more likely to be used by mothers of typically developing children. Recasts were used more frequently during joint reading. Notwithstanding these differences in recast use, no significant difference was observed in the children's responses. McGinty et al. (Reference McGinty, Justice, Zucker, Gosse and Skibbe2012) examined the relationship between mothers’ question use and the participation of preschool children with SLI during shared reading. Mothers’ question use did not facilitate higher levels of verbal participation by these children. Moreover, children's level of verbal participation did not influence the topic directiveness or cognitive challenge of mothers’ question use.

Impact and outcomes in SLI

At 4;8 years, DF will soon enter the school system. At this stage, his severe expressive language problems may have a number of serious consequences including poor academic attainment and problems in establishing peer relationships. DF may also be at an increased risk of victimisation and bullying. These possible consequences of DF's language disorder are suggested by the findings of studies that have reported significant, adverse academic and psychosocial impacts of SLI in children. Moreover, these impacts continue to be experienced by individuals with SLI long after the completion of compulsory education at the age of 16 years. Typically, this takes the form of reduced vocational opportunities and problems with social relationships. Some of these studies’ findings are examined in this unit.

For school-age children, SLI can have significant psychosocial and academic impacts. Redmond (Reference Redmond2011) examined peer victimisation levels in 7- to 8-year-old children with SLI, children with attention deficit hyperactivity disorder (ADHD) and typically developing children. Clinical status was found to be associated with elevated levels of victimisation, particularly for children with SLI. For typically developing children and children with ADHD, there was a potential buffering effect for number of close friendships. However, this did not exist for children with SLI. Conti-Ramsden et al. (Reference Conti-Ramsden, Durkin, Simkin and Knox2009) examined the educational outcomes of 120 adolescents with a history of SLI at the end of compulsory education. The results of national educational examinations were analysed. At least one of the expected qualifications was obtained by 44% of young people with SLI (88% of adolescents with typical development obtained the same level of qualifications). Among the adolescents with SLI, 24% was not entered for any examinations at the end of compulsory education (only 1% of adolescents with typical development was not entered for any examinations). After controlling for IQ and maternal education, literacy and language skills were predictive of educational attainment.

For young people with SLI, the completion of compulsory education and entry into the workplace bring new, additional challenges. Conti-Ramsden and Durkin (Reference Conti-Ramsden and Durkin2012) interviewed 50 19-year-olds with SLI about their education and employment experiences since finishing compulsory secondary education. Young people with SLI were on average less successful than peers without SLI, obtaining approximately two, mostly vocational qualifications in the first few years post school. For those who continued in education at 19 years, they were most commonly in lower educational placements than their typically developing peers. A larger proportion of young people with SLI were not in education, employment or training at 19 years of age. Whitehouse et al. (Reference Whitehouse, Watt, Line and Bishop2009a) examined the adult psychosocial outcomes of children with SLI, pragmatic language impairment (PLI) and autism spectrum disorder (ASD). Individuals with SLI were more likely than individuals with PLI and ASD to pursue vocational training and to work in jobs that do not require a high level of language/literacy ability. All groups had problems establishing social relationships, and some individuals in each group experienced affective disturbances.