The recent issue
of the International Journal of Language and Communication Disorders
focussing on nomenclature for children with impaired language skills is both
timely and thought-provoking. The open access papers are written by pre-eminent experts in child
language research and provide an important melting pot of current ideas,
tensions, conundrums and importantly, some suggestions as to sensible ways
forward. I have only managed a “first pass” read of the papers so far and need
to sit and re-read them to absorb them properly, but offer here some initial
ideas and responses – which may change of course, as my re-reading helps the
ideas percolate further.
Firstly, let
me say I have been as guilty as the next person of being inconsistent in how I
use terminology in relation to language difficulties / disorders / impairments
/ problems / deficits. Ironically though, the one term I have been able to comfortably avoid in recent years is Specific Language Impairment (SLI), because my
research with young people in the youth justice and child protection systems
tells me that their language difficulties, while both marked and common, are
not at all “specific” in the sense in which this word has been used in the SLI
literature over the past two decades. In
our 2011 paper describing the expressive and receptive language skills of 100
young offenders completing custodial orders, in whom (using what was probably
an overly conservative cut-off) we identified 48% as “language impaired”, and
observed that:
“While it is possible that some may meet diagnostic criteria
for Specific Language Impairment (SLI), it is more likely that the patterns of
decrement evident in this group are of a generalized and non-specific nature - reflecting
perhaps early disruptions in attachment, low parent–child attunement, and other
socio-environmental factors that militate against the development of robust
oral language skills”
(Snow & Powell, 2011, pp. 486-87).
I agree with Reilly et al. when they state (p.423) that
“…making a conceptual distinction between ‘real’ language impairment and children for whom the environment has caused their language impairment may be simplistic”.
It follows, then, that I support the view that the descriptor “specific” is unhelpful, both nosologically and with respect to allocation of intervention services. Many children and adolescents have clinical profiles that reflect clear need with respect to their language skills, yet these are anything other than “specific” in the sense in which this term was intended to be applied. I am comfortable describing young offenders as having “language impairments” because their expressive and receptive language skills are not adequate to enable them to meet everyday social, academic, vocational communication demands. In reality of course, many of these young people are coming from a literal “deficit” position with respect to language exposure and experience, but the term deficit has unhelpful connotations and will be even less likely to gain traction than its more widely known and used counterpart “impairment”.
When I think about the young people in our youth
justice / child protection studies and their language profiles, this is the way I think about the complex developmental
pathways that in many cases result in impaired language skills:
In reality, the diagram should be a lot busier, showing arrows from each point of intersection between different risk factors, but that would make it visually unworkable.
It is of course not possible in this line of research to
partial out contributory mechanisms (or their interactions). The important
take-home message for policy makers and schools in particular, is that language
skills in already vulnerable young people are fragile. I fully support the
arguments presented by both Dorothy Bishop and by Reilly et al. that
discrepancy-based diagnostic criteria (i.e. excluding children with nonverbal
IQs below certain arbitrary cut-offs) are not helpful in deciding who does or
does not have a language impairment. A language impairment exists when you do
not have sufficient expressive and /or receptive skills to verbally navigate
your way through the business of everyday life at the expected developmental
level. Low IQ may sometimes explain some of this difficulty, but is not an “opt-out”
clause with respect to explaining poor language functioning, or determining who might benefit from intervention services.
It is pleasing to see a focus in Dorothy Bishop’s
paper on fostering children’s skills and interests that are not reliant on
language/literacy achievement, and of course I fully agree with such a strengths-based
approach. Improved self-esteem and a sense of achievement are important in their own
right, and also for school attachment and retention. Sadly though, we need to recognise
that in industrialised, first world countries, the job market is going to rely
more, rather than less, on language and literacy skills. We only need to look
to our local supermarkets for evidence that low-skill jobs (working as a
cashier) are disappearing and are being replaced by high-skill jobs (designing,
installing and maintaining self-checkout points).
Children with language impairments grow into adolescents with language impairments, who of course emerge as adults with language impairments. Such impairments are sometimes superficially masked by behavioural and mental health issues, but they are not lost on employers. In 2011, the Industry Skills Council of Australia published a report stating (p. 1) that
Literally millions of Australians have insufficient language, literacy and numeracy skills to benefit fully from training or to participate effectively at work
Non-specific language impairment is likely to be what
turns up in classrooms and on SLP caseloads – so I’d like to see the term “specific”
dropped and would be happy to run with “language impairment” OR “language-learning
impairment”. Both are closer to the reality of complex underlying causal
pathways, and the latter has an important link to academic achievement. However both would need to be “sold” to policy makers and funding bodies with
respect to the prevalence and life-span importance of the problems to which they refer.
A further reason to drop the descriptor "specific" is that this would remove the (false) two-tiered hierarchy between those children whose language impairment is "pure" and those in whom other developmental threats to language competence (as per my diagram above) are identifiable. We only need to look to the world of "dyslexia" Vs "reading difficulties" to see how unhelpful such hierarchies are in practice. Researchers will of course continue to investigate children whose language impairments are ideopathic, and will need to convince funding bodies of the empirical and applied importance of doing so.
A further reason to drop the descriptor "specific" is that this would remove the (false) two-tiered hierarchy between those children whose language impairment is "pure" and those in whom other developmental threats to language competence (as per my diagram above) are identifiable. We only need to look to the world of "dyslexia" Vs "reading difficulties" to see how unhelpful such hierarchies are in practice. Researchers will of course continue to investigate children whose language impairments are ideopathic, and will need to convince funding bodies of the empirical and applied importance of doing so.
Oral language competence is a complex output that requires
complex inputs. The bottom line for me is that language experts, whether from
psychology, speech language pathology, education, paediatrics, or public health need to make a lot of
noise about oral language competence – what it is, why it matters, and how to
strengthen its chances, right from birth. Deciding what we will call its
inverse will be an important part of the way forward.
I’m looking forward to
thinking and reading further and will be interested to see how others react to
these important papers.
References
Bishop, D.V.M.
(2014). Ten questions about terminology for children with unexplained
language problems. International Journal of Language and Communication Disorders,
49(4), 381–415.
Reilly, S., Tomblin, B., Law, J., McKean, C., Mensah, F.K., Morgan,
A., Goldfeld, S., Nicholson, J.M. & Wake, M. (2014). Speciļ¬c language
impairment: A convenient label for whom? International Journal of Language
and Communication Disorders, 49(4), 416-451.
Tweet Snow, P.C. & Powell, M.B. (2011). Oral language competence in incarcerated young offenders: Links with offending severity. International Journal of Speech-Language Pathology 13(6), 480-489.
© Pamela Snow 2014
