1

Specific Language Impairment (SLI): Outcomes in Adolescence

Gina Conti-Ramsden

The University of Manchester

Kevin Durkin

University of Strathclyde

2

1Specific Language Impairment (SLI): Outcomes in Adolescence

Children and young people with specific language impairment (SLI) represent a

group of individuals who have deficits in language ability whilst “everything else”

appears to be normal. That “everything else” includes, by definition, adequate input from

the senses: normal hearing and normal/corrected vision. It also includes an adequate

biological basis to develop language (they have no obvious signs of brain damage) and an

adequate basis for learning, i.e., their nonverbal abilities as measured by IQ are similar to

those of their peers of the same age. A desire to engage socially is also important:

children and young people with SLI seek to interact socially with adults and peers and as

such are not like children with autism who are not as socially engaged. This definition of

SLI which is commonly in use has a number of key implications for our understanding of

the impairment.

First, SLI is conceived as a primary difficulty with language. Indeed all young

children who are likely to later have SLI are in the first instance late talkers in the non-

technical sense. That is, the appearance of their first words is delayed compared to what

is expected of most young children. Word combinations such as “want juice”, “bye-bye

teddy” also appear at a later age than would be expected. This is true for children learning

not just English, but any language. Generally, across languages, children with SLI are

described as having more difficulty with talking (producing words) than with

understanding what is said to them (comprehending language). Although difficulties

with talking attract the most attention and can occur in isolation, many children present

1 The contents of this chapter have been presented in previous publications, in particular, Conti-Ramsden (2008) and Durkin & Conti-Ramsden (2007).

3

with difficulties in both talking and understanding. It is much more rare to see children

who have problems understanding what is said to them but can talk normally (except in

the case of some children with autism).

Second, in SLI this primary difficulty with language is assumed to hold the key to

the explanation of why these children have difficulties. In other words, there is an

assumption that the language deficit is a manifestation of something wrong with whatever

the language learning mechanism may be. In the definition of SLI, other possible causes

of a language difficulty are excluded: the child does not have hearing problems so the

hearing is not causing the language difficulty. In the same vein, the child does not have

learning difficulties so these can not be causing the language difficulty. The child

appears to be social and want to communicate, so interpersonal, social difficulties can not

be causing the language difficulty.

Third, in SLI this primary difficulty with language is assumed to be a defining

characteristic that, if unresolved, stays with children as they reach adolescence and young

adulthood. We do not see in textbooks or manuals a change in the definition of SLI from

childhood to adolescence, for example. Textbooks and manuals are likely to acknowledge

that SLI is a developmental condition, that it can be persistent and stay with children as

they grow up, and that it can be heterogeneous. Yet, the current definition of SLI most

commonly used is in a way static and does not explicitly tell us about what to expect as

children with SLI grow up.

In this chapter we will examine precisely this issue: what are the developmental

outcomes for SLI in adolescence and what do these outcomes tell us about the nature of

SLI itself? We will base our observations on our longitudinal investigation of SLI: the

4

Manchester Language Study. Furthermore, we will argue that the accumulating findings

on outcomes in adolescence prompt a revision of the assumptions outlined above; that is,

the evidence suggests that SLI is interwoven with other difficulties.

The Manchester Language Study

This investigation began with an original cohort of 242 children who represented

a random 50% of all children attending year 2 (aged 7 years old) in language units across

England. Language units in England are classes, usually one or two attached to

mainstream schools, that offer specialist language environments for children with SLI.

The staff:student ratio in these mixed-aged classes is high, at one staff member for

approximately 10 students. Staff include a specialist teacher and a classroom or speech

therapy assistant as well as regular speech and language therapy input provided by a

qualified therapist (for more information on language units and educational provision for

children with SLI in England see Conti-Ramsden & Botting, 2000). Children reported by

teachers to have frank neurological difficulties (brain damage), diagnoses of autism,

known hearing impairment or general learning impairments were excluded. All children

had English as a first language, but 12% had exposure to languages other than English at

home. In our original sample, 53.1% of the participants came from households earning

less than the average family wage for that year. The cohort has been assessed at 8 years

of age (n=234), 11 years of age (n=200), at 14 years of age (n=130) and 16 years of age

(n = 139). The adolescents who agreed to participate at 16 years, and that form the basis

of the data to be discussed in this study, did not differ on any early variables of language,

behaviour, cognition or social-economic status (SES) compared to those who did not

5

participate. The adolescents showed a variety of different language profiles, with the

majority described as having both receptive and expressive difficulties.

At age 16 years, the Manchester Language Study expanded to include a

comparison group of adolescents from a broad background who did not have a history of

special educational needs or speech and language therapy provision. In total, 124 young

people with normal language development (NLD) aged between 15 years 2 months and

16 years 7 months (mean age 15;11 years) agreed to participate. Census data as per 2001-

2002 General Household Survey (UK Office of National Statistics) were consulted in

order to target adolescents who would be representative of the range and distribution of

households in England in terms of household income and maternal education. In post-hoc

analysis, there was also no significant difference between NLD adolescents and

adolescents with SLI in maternal education levels (χ2(2)=1.756, p=.416) or household

income bands (χ2(3)=4.391, p=.222). There were also no significant differences in the

proportions of girls in each group (SLI=42/139; NLD=47/124; Fisher’s exact p=0.20).

Table 1 presents the characteristics of the adolescents with SLI and NLD adolescents in

terms of their age, current language and cognitive functioning. Language and cognitive

functioning are derived from standardized tests with a mean of 100 and a standard

deviation of 15. Thus, a score between 85 and 115 (i.e. within one standard deviation of

the mean) is indicative of normal performance and 68% of scores from typical

adolescents would fall within this range. As can be seen from the results presented in

Table 1, the group of adolescents with SLI had means below 85 on the three measures

presented.

6

Outcomes at 16 Years: Literacy, Friendships and Emotional Health

To meet the definition of SLI currently in use, we would expect these adolescents

to have selective impairments in language functioning. Deficits outside the language

system may be a consequence of having impaired language or they may be caused by

other concomitant deficits. What is crucial is to examine other areas of functioning in

SLI and to do so beyond childhood. We have examined a number of areas of functioning

as part of our work including educational achievement (Conti-Ramsden, Durkin, Simkin,

& Knox, 2009; Durkin, Simkin, Knox, & Conti-Ramsden, 2009), independence (Conti-

Ramsden, & Durkin, 2008), shyness (Wadman, Durkin, & Conti-Ramsden, 2008) and use

of new media (Durkin, Conti-Ramsden, Walker, & Simkin, 2009). In this chapter we

focus on three areas of related functioning: literacy, friendships and emotional health.

Literacy outcomes

Recent evidence increasingly suggests that children with SLI are likely to

experience literacy problems (e.g. Catts, 1991; Catts, Fey, Tomblin, & Zhang, 2002;

Conti-Ramsden, Donlan, & Grove, 1992; Snowling, Bishop, & Stothard, 2000) and

children who have reading problems, i.e. dyslexia, are likely to experience difficulties

with oral language skills beyond the area of phonology (Joanisse, Manis, Keating, &

Seidenberg, 2000; McArthur, Hogben, Edwards, Heath, & Mengler, 2000). The literature

suggests there is an overlap of about 50%. As noted by Snowling and Hulme (2008),

literacy builds on a foundation of oral language skills. Decoding skills are closely related

to phonological abilities, whereas reading comprehension is more closely allied to non-

phonological language skills (Bishop & Snowling, 2004). Thus, it is not surprising that

the results of a number of studies suggest an association between reading skills and the

7

language profiles of children with SLI. Some investigators have focused on global

measures such as the severity of the language impairment. Children’s level of

performance on standardised tests of language expression (talking) and language

understanding have been found to be closely associated with reading achievement (e.g.,

Bishop & Adams, 1990; Tallal, Dukette, & Curtiss, 1989; Wilson & Risucci, 1988).

Furthermore, Bishop (2001) argues that the risk of developing literacy difficulties

increases with the number of impaired language domains the child experiences, i.e.

language expression and language understanding. In this extensive twin study involving 8

year olds, Bishop found that 29% of children with SLI who were impaired in one

language domain had difficulties with reading. In contrast, a much larger proportion of

children with SLI (72%) who were impaired in two language domains had difficulties

with reading.

Thus, there appears to be substantial evidence to suggest that children with SLI

are likely to experience reading difficulties at school age. In addition, it appears that

children with SLI who have severe impairments or impairments in more than one domain

of language appear to be at higher risk of developing reading difficulties.

We investigated two different types of reading outcome: reading accuracy and

reading comprehension (see also Botting, Simkin, & Conti-Ramsden, 2006). Reading

accuracy refers to the ability to decode what the words are, for example to read them out

loud. Reading comprehension is about understanding what has been read, for example to

answer some questions about a story. Interestingly, reading accuracy and reading

comprehension have been shown to be dissociated in the development of some atypical

populations. This includes those with dyslexia, whose decoding/accuracy skills tend to be

8

poorer than comprehension skills (Bishop & Snowling, 2004) and poor comprehenders

who (by definition) show average reading accuracy in the context of poor text

comprehension (Cain & Oakhill, 1996).These different reading outcomes may also show

different rates of impairment in children with SLI. In our study of 16 year olds and in line

with previous research (Snowling et al., 2000), we found that adolescents with SLI had

more difficulties with reading comprehension than with reading accuracy (see Table 2 for

details). We then examined predictors of reading outcome. How much do concurrent

language skills predict reading outcome? How does concurrent language fare as a

predictor in relation to other factors such as nonverbal IQ?

Our results suggest that language expression and language understanding were

associated with reading accuracy and reading comprehension. Language was the

strongest predictor, explaining 30% of the variance, with nonverbal IQ also influencing

these outcomes. Thus, the predictor variables were, in order, language followed by

nonverbal IQ.

There was evidence of variability in literacy outcomes, i.e. heterogeneity within

our sample of adolescents with SLI. In addition to the information illustrated above in

table 2, the box below illustrates the fact that we find, amongst young people with a

history of SLI, a proportion of adolescents that are competent readers.

9

●Approximately one quarter of the young people had reading accuracy and

comprehension scores 1SD above the expected mean

In summary, these results show that joint impairment of language understanding

and production in SLI is associated with outcome in literacy skills at 16 years of age, i.e.,

even when IQ is controlled for, concurrent language skills have an important predictive

contribution to reading skills at 16 years. Tests involving structural aspects of

language/syntax, both in the expressive and language understanding domains, are the

most implicated in this association. A number of studies have shown an association

between oral language skills and reading comprehension. Similarly to the present study,

Tallal, Curtiss and Kaplan (1988) and Wilson and Risucci (1988) found that spoken

language comprehension deficits predicted later reading difficulties in children with SLI.

However, although our results are in line with this conclusion, the present study indicates

that expressive language skills also show associations with reading comprehension ability

and thus is consistent with studies of young children with SLI where mean length of

Competent readers (24%)

Both reading accuracy and comprehension difficulties (47%)

Reading accuracy difficulties only (2%)

Reading comprehension difficulties only (27%)

10

utterance (MLU) has been found to be a predictor of reading ability (e.g. Bishop &

Adams, 1990). At the same time, it must be noted that regardless of relative language

ability, this population of young people is at very great risk of reading impairment in

adolescence: 76% of our participants showed reading difficulties. Only a relatively small

minority of ‘competent readers’ were found in our group, demonstrating a strong

association between oral language skills and literacy abilities in adolescence. In terms of

competent readers, it was found that 63% had age appropriate concurrent language scores

as measured by the Clinical Evaluation of Language Fundamentals (CELF-R, Semel,

Wiig & Secord, 1987). The remainder had language difficulties that were nearly all

expressive in nature (as measured by the CELF-R Recalling Sentences subtest).

Friendships

Durkin and Conti-Ramsden (2007) describe friendships as being a vital

dimension of child development. They are key markers of the selectivity of interpersonal

relations, providing social and cognitive scaffolding (Hartup, 1996), serving variously as

sources of support and information as well as buffers against many of life’s problems,

with enduring implications for self-esteem and wellbeing (Hartup & Stevens, 1999;

Shulman, 1993). Children and adolescents without friends, or with poor friendship

quality, are at risk of loneliness and stress (Bagwell et al., 2005; Hartup & Stevens, 1999;

Ladd, 1990; Ladd, Kochenderfer, & Coleman, 1996).

Friendship relations are complex and this reflects in part the ways in which they

interweave with other developmental processes, such as developing interpersonal and

communicative skills, increasing social cognitive competence and changing personal

11

needs. For example, very young children form friendships largely on the basis of

proximity and shared activities; during middle childhood friendships involve greater

levels of interchange and awareness of individual attributes; and in adolescence many

people seek via friendships to satisfy psychological needs for intimacy, shared outlooks

and identity formulation (Buhrmester, 1990, 1996; Hartup & Stevens, 1999; Parker &

Gottman, 1989; Steinberg & Morris, 2001).

In the case of children with language impairments, it appears that they are at a

disadvantage in peer relations from at least their preschool days. They engage less in

active conversational interactions than typically developing peers, enter less frequently

into positive social interactions, are less sensitive to the initiations offered by others, have

poorer discourse skills, manifest situationally-inappropriate verbal responses, achieve

fewer mutual decisions and are more likely to have their bids to influence others prove

unsuccessful (Brinton, Fujiki, & McKee, 1998; Craig, 1993; Craig & Washington, 1993;

Grove, Conti-Ramsden, & Donlan, 1993; Guralnick, Connor, Hammond, Gottman, &

Kinnish, 1996; Hadley & Rice, 1991; Vallance, Im, & Cohen, 1999). In short, the

communicative basis for close reciprocal relationships is circumscribed by SLI.

Communicative abilities are not the only factors that may impede peer relations in

individuals with SLI. These children tend also to score lower than typically developing

children on a range of measures of social skills, social cognitive abilities and emotional

and behavioral self-regulation (Cohen, Barwick, Horodezky, Vallance, & Im, 1998;

Fujiki, Brinton, & Clarke, 2002; Fujiki, Brinton, & Todd, 1996; Lindsay & Dockrell,

2000; Marton, Abramoff, & Rosenzweig, 2005). Young people with SLI tend to be rated

as more withdrawn than age-matched comparisons (Brinton & Fujiki, 1999; Cohen et al.,

12

1998; Fujiki et al., 1996; Fujiki, Brinton, Isaacson, & Summers, 2001; Redmond &

Rice, 1998) yet they are at heightened risk of exhibiting externalizing problems and

antisocial conduct disorders (Beitchman et al., 2001; Conti-Ramsden & Botting, 2004;

Brownlie et al., 2004).

Children with SLI are less likely to exhibit skilled prosocial behavior. Fujiki,

Brinton, Morgan, and Hart (1999) reported that participants (aged 5 to 13 years) with

language impairments were rated significantly below typical peers on teacher ratings of

prosocial behavior. Conti-Ramsden and Botting (2004) found that detailed case studies

presented by Brinton, Fujiki, Montague and Hanton (2000) suggest that language

difficulties, social withdrawal and a lack of prosocial skills are compounded, with the

outcome that children find it difficult to work in collaborative peer groups. Stevens and

Bliss (1995) found that children with SLI were less likely to propose prosocial

(cooperative) solutions to conflicts. Thus, deficits in other fundamental interpersonal

capacities appear to be associated with SLI. Indeed, children with SLI have been found

to have fewer friends and appear to be less satisfied with peer relationships compared to

age-matched classmates (Fujiki et al., 1996). Fujiki et al. (1999) conducted a detailed

examination of peer relations in eight children aged six to 11 years with SLI attending

mainstream schools. Peer sociometric ratings and reciprocal friendship nominations were

collected from the target children and their classmates. Strikingly, five of the eight

children with SLI were not named by any child as a best friend; two of the children with

SLI who named other children as their best friends received the lowest possible ratings on

the sociometric scale. In short, these children appeared not only to have impoverished

13

friendship relations but, in some cases, had inaccurate perceptions of the status of their

relationships with others.

Accumulating evidence confirms that social and behavioral difficulties in this

group are not short-term problems. A pattern of social difficulties is characteristic not

only of relatively early peer relations but remains marked through later childhood and

adolescence (Brinton, Fujiki, & Higbee, 1998; Brinton, Fujiki, Spencer, & Robinson,

1997; Conti-Ramsden & Botting, 2004; Fujiki, Brinton, Robinson, & Watson, 1997;

Stevens & Bliss, 1995), and into adulthood (Clegg, Hollis, Mawhood, & Rutter, 2005;

Howlin, Mawhood, & Rutter, 2000). However, in the context of conduct disorders and

other manifest problems, relative impoverishment of friendship development may be less

salient for caregivers and teachers (Conti-Ramsden & Botting, 2004).

Although there are several studies pointing to problems in peer acceptance and

friendship formation among children with SLI, much less is known of the patterns in

adolescence, notwithstanding the widely acknowledged heightened importance of peer

relations at this stage of life. More generally, there is a dearth of longitudinal study of

friendships and the factors that influence them (Hartup, 1996), especially in relation to

children with SLI (Farmer, 2000). In our Durkin and Conti-Ramsden (2007) paper we

aimed to address this gap and examined friendship quality in our sample of adolescents

with SLI and their NLD peers at age 16 years. We asked them a series of questions

regarding friends and acquaintances, for example, how easy do you find to get on with

other people? If you were at a party or social gathering, would you try to talk to people

you had not met before? Based on a number of questions we devised a scale ranging

from 0 to 16 points, with scores closer to zero representing good quality of friendships.

14

Adolescents in the SLI group ranged from 0 to 14 points while adolescents in the NLD

group had scores between 0 to 2. Overall, as a group, adolescents with SLI were at risk

of poorer quality of friendships.

We then examined predictors of friendships. Our results suggest that spoken

language abilities (expression and understanding of language) as well as literacy skills

(reading) were associated with friendship quality. But language was not the strongest

predictor, these were difficult behaviour and prosocial behaviour. We found that, in the

sample as a whole, language and literacy measures accounted for an additional 7% of

variance. Thus, language ability is predictive of adolescents’ friendship quality when

other behavioural characteristics known to be influential in peer relations (problem

behavior, prosocial behavior) are controlled for, but its overall influence is small. There

was also a small influence of nonverbal IQ. Thus, the predictor variables were, in order,

difficult behaviour, prosocial behaviour, language and literacy, and nonverbal IQ.

There was also evidence of variability in friendship quality, i.e. heterogeneity

within our sample of adolescents with SLI. The box below illustrates the fact that we find

a large proportion of adolescents with SLI that have good quality of friendships. In

Durkin and Conti-Ramsden (2007) factors that potentially distinguish between those with

good quality of friendships (60%) and those with poor quality of friendships (40%) are

examined in detail. Briefly, the findings suggest a marked developmental consistency in

the pattern of poor language for the poor friendships group across a 9 year span, from 7 to

16 years of age.

15

● Six out of ten adolescents with SLI report good quality of friendships.

Specific language impairment itself appears to be a risk factor for poorer

friendship development. At the same time, there are individual differences in the nature

and severity of problems experienced. Although we found that the group of participants

with SLI as a whole scored less favorably on our measure of friendship quality, they also

showed considerable within-group heterogeneity, and many (60%) had good scores with

about 40% having poor quality of friendships. These data taken together suggest that poor

quality of friendships in SLI, although related to poor language, may not be simply a

consequence of the severity of the language problem experienced but is an additional

difficulty present in SLI, particularly evident during adolescence.

Emotional health

There have been some studies examining quality of life and psychiatric outcomes

in young people with SLI (Cantwell & Baker, 1987; Beitchman et al., 2001; Clegg et al.,

2005). Beitchman and colleagues followed up a group of children with SLI from 5 to 19

years and throughout this period they assessed them for the presence of possible

Good quality of friendships 60%

16

psychiatric difficulties. They found that children with SLI were at greater risk of having

attention deficit hyperactivity disorders (Beitchman et al., 1996) and later had higher

rates of anxiety disorders (Beitchman et al., 2001), aggressive behaviour (Brownlie et al.,

2004) and higher levels of substance abuse (Beitchman et al., 2001). Clegg and

colleagues (2005) followed a cohort of children from 4 years to mid adulthood and found

greater risk of psychiatric impairment (compared to both peers and siblings), particularly

concerning depression, social anxiety and schizoform/personality disorders. Other studies

have examined language in populations referred primarily for psychiatric difficulties.

Cohen and colleagues (1998), for example, found a higher than expected rate of

undiagnosed language impairment (40%) in their clinic sample. In contrast, however, it

needs to be noted that a recent study of SLI (Snowling, Bishop, Stothard, Chipchase &

Kaplan, 2006) did not identify higher risk of emotional disorders at all. Thus, still

relatively little is known about the long-term emotional health outcomes for children with

SLI and the available literature yields somewhat mixed results. Therefore, we

investigated the occurrence of emotional symptoms such as anxiety and depression in our

cohort at 16 years of age (Conti-Ramsden & Botting, 2008).

As can be seen from Table 3, adolescents with SLI had higher scores for both

anxiety and depression. In addition, the proportion of adolescents scoring above the

clinical threshold was larger in the SLI group as compared to the NLD group for both

anxiety (12% vs. 2%) and depression (39% vs. 14%).

We then examined predictors of emotional health. Our results suggest that there

were virtually no associations between language ability and the development of

emotional health symptoms. Examination of earlier factors (at 7 years) suggests that

17

those with emotional problems at 7 years also show increased anxiety at 16 years. Earlier

language once again showed remarkably few associations. Thus language was not a

predictor of emotional health in adolescents with SLI.

There was also evidence of variability in emotional health symptoms, i.e.

heterogeneity within our sample of adolescents with SLI. The box below illustrates the

fact that we find, amongst adolescents with SLI, a large proportion of individuals have

adequate emotional health.

●Nearly two-thirds of adolescents with SLI have little anxiety or depression symptoms.

In summary, the results of the above investigation raise a number of key issues

which relate to the risk of emotional health symptoms in young people with SLI. Firstly,

our data show a clear increased risk for this population as they near adulthood compared

to peers. This finding replicates other studies that have shown raised prevalence of

psychiatric difficulties in those with communication impairments (e.g., Clegg et al.,

2005) and increased language impairment in children referred psychiatrically (e.g.,

Cohen et al., 1998) and reviews affirming the association (Toppelberg & Shapiro, 2000).

Adequate mental health 60%

18

Beitchman and colleagues (2001) in particular found increased anxiety in a similar cohort

with SLI at 19 years of age. The association has often been assumed to be causal in that

either long-term language impairment may lead to (or exacerbate) wider difficulties, or

that psychiatric impairment may constrain communication skill. However, apart from the

fact that those with SLI have increased symptoms, surprisingly few clear associations

have been identified between language and the development of emotional health

symptoms. This is similar to the findings of Clegg and colleagues (2005), who also failed

to find a clear relationship between the two. The lack of association with language scores

thus makes it more difficult to interpret the relationship between having poor language

and emotional health difficulties as a directly developmentally causal one: that is having

ongoing poor communicative experiences do not appear to ‘make you’ increasingly

depressed or anxious per se. Rather, the association appears to be with SLI itself, with

the disorder. Thus, other factors are likely to play a role in making some individuals

more vulnerable. From our own work we suggest these can range from family history of

anxiety and depression (Conti-Ramsden & Botting, 2008) to environmental factors such

as being bullied (Knox & Conti-Ramsden, 2007). Interestingly, poor quality of

friendships do not appear to be strongly associated with mental health difficulties. We

found that, in our sample, only 7% of adolescents showed difficulties in both friendships

and mental health; 32% showed difficulties with friendships in the context of adequate

mental health and 4% had the reverse pattern. Over half (57%) of the sample did not

show difficulties in either area.

What do Outcomes in Adolescence Tell Us About the Nature of SLI?

19

The findings presented briefly above point to the heterogeneity in outcomes in

SLI. This heterogeneity is present within individuals as well as across individuals.

Within the individual, there appears to be variation in the constellation of difficulties an

individual may experience throughout development, in the severity of these difficulties,

and in the dynamic nature of these difficulties as these may not be stable across time.

Among those with SLI, different adolescents may have different types of difficulties of

different severity.

The concern that SLI is not a pure disorder of language is not a new idea (e.g.

Leonard 1987; 1991; 1998). What is perhaps debated but less well established is the

suggestions that we want to make here: that at least some of the associated difficulties

present in SLI are not directly related to the language difficulties present in SLI. We want

to argue that the heterogeneity observed in the outcomes of adolescents with SLI, both

within and across individuals, is a reflection of SLI being more than a language problem.

The evidence points to a need to redefine SLI.

SLI is a developmental disorder for which language is a primary manifestation in

early childhood. It is the case that there are a number of children (and not such a small

number, 5 to 7% is the estimated incidence amongst 5 year olds, Tomblin et al., 1997) of

pre-school age who present with primary language problems with other areas of

development apparently intact. The issue is that this profile of SLI does not remain this

way for long for a large proportion of children as they grow up. Other areas of

functioning may show deficits, including areas which can not be related directly to

language per se. SLI has associated difficulties which become more evident with

20

development, only some of which are related to the severity and type of language

problem experienced.

In SLI the primary difficulty with language is assumed to hold the key to the

explanation as to why these children have these difficulties with language and other

areas. The evidence presented in this chapter in terms of outcomes at 16 years suggests

that factors other than difficulties with language may well be crucial in understanding the

range of outcomes that individuals with SLI experience throughout their childhood and

adolescence. In the specific case of our work on social interaction and friendship quality,

for example, it is important to bear in mind that language problems are not a guarantee of

social problems. Indeed, although social difficulties may distinguish children with SLI

from their typical peers, they are not usually in the clinical range (Botting & Conti-

Ramsden, 2000; Redmond & Rice, 1998). Children with SLI are heterogeneous in terms

of their language characteristics, and this holds true for their social abilities too: Some

children with SLI achieve high levels of peer popularity (Brinton & Fujiki, 2002; Fujiki

et al., 1999). In the evidence provided in this chapter, a very positive finding is that some

60% of adolescents with SLI had reported friendship quality in the good range. This

provides reassuring news that successful peer relations are indeed possible. While better

language ability contributes part of the explanation of these favourable outcomes, it is

clear that other factors are involved and that it is possible that strengths in one or more of

these can mitigate any effects due to impaired language.

In sum, our work with a large sample of individuals with SLI illustrates the wide

variation in outcomes observed in adolescence: from competent readers to very poor

readers; from those enjoying good quality of friendships to those with difficulties

21

developing such relationships; from those experiencing anxiety and/or depressive

symptoms to those having adequate emotional health. This heterogeneity in outcomes

represents a challenge to researchers as well as practitioners. Further work is required on

the identification of factors affecting developmental trajectories of individuals with SLI

as well as on the development of supportive practice for the potentially changing needs of

individuals with SLI across their lifespan.

22

Author Note

The authors gratefully acknowledge the support of the Nuffield Foundation

(grants AT 251 [OD], DIR/28 and EDU 8366), the Wellcome Trust (grant 060774), and

the Economic and Social Research Council (ESRC) for a fellowship to Gina Conti-

Ramsden (RES-063-27-0066). Correspondence concerning this chapter should be

addressed to Gina Conti-Ramsden, Human Communication and Deafness, School of

Psychological Sciences, The University of Manchester, Ellen Wilkinson Building,

Oxford Road, Manchester, M13 9PL UK. E-mail: gina.conti-ramsden@manchester.ac.uk

23

References

Bagwell, C. L., Bender, S. E., Andreassi, C. L., Kinoshita, T. L., Montarello, S. A., & Muller, J.

G. (2005). Friendship quality and perceived relationship changes predict psychosocial

adjustment in early adulthood. Journal of Social and Personal Relationships 22, 235-254.

Beitchman, E. B., Brownlie, E. B., Inglis, A., Ferguson, B., Schachter, D., Lancee,

W., Wilson, B., & Mathews, R. (1996). Seven-year follow-up of speech/language

impaired and control children: Psychiatric outcome. Journal of Child Psychology and

Psychiatry, 37, 961-970.

Beitchman, J. H., Wilson, B., Johnson, C. J., Atkinson, L., Young, A., Adlaf, E., Escobar, M., &

Douglas, L. (2001). Fourteen year follow-up of speech/language impaired and control

children: Psychiatric outcome. Journal of the American Academy of Child and Adolescent

Psychiatry, 40, 75-82.

Bishop, D.V.M. (2001). Genetic influences on language impairment and literacy problems in

children: Same or different? Journal of Child Psychology and Psychiatry, 42, 189-198.

Bishop, D. V. M., & Adams, C. (1990). A prospective study of the relationship between specific

language impairment, phonological disorders and reading retardation. Journal of Child

Psychology and Psychiatry, 31, 1027-1050.

Bishop, D. V. M., & Snowling, M. J. (2004). Developmental dyslexia and specific language

impairment: same or different? Psychological Bulletin, 130, 858-886.

Botting, N., & Conti-Ramsden, G. (2000). Social and behavioural difficulties in children with

language impaiment. Child Language, Teaching and Therapy, 16, 105-120.

24

Botting, N., Simkin, Z., & Conti-Ramsden, G. (2006). Associated reading skills in children with

a history of specific language impairment (SLI). Journal of Reading and Writing, 19(1),

77-98.

Brinton, B., & Fujiki, M. (1999). Social interactional behaviors of children with specific

language impairment. Topics in Language Disorders, 19, 46-69.

Brinton, B., & Fujiki, M. (2002). Social development in children with specific language

impairment and profound hearing loss. In P. K. Smith & C. H. Hart (Eds.), Blackwell

handbook of childhood social development (pp. 588-603). Blackwell: Malden, MA.

Brinton, B., Fujiki, M., & Higbee, L. M. (1998). Participation in cooperative learning activities

by children with specific language impairment. Journal of Speech, Language, and

Hearing Research, 41, 1193-1206.

Brinton, B., Fujiki, M., & McKee, L. (1998). Negotiation skills of children with specific

language impairment. Journal of Speech, Language and Hearing Research, 41, 927-940.

Brinton, B., Fujiki, M., Montague, E. C., & Hanton, J. L.(2000). Children with language

impairments in cooperative work groups: A pilot study. Language, Speech and Hearing

Services in Schools, 31, 252-264.

Brinton, B., Fujiki, M., Spencer, J. C., & Robinson, L. A. (1997). The ability of children with

specific language impairment to access and participate in an ongoing interaction. Journal

of Speech, Language and Hearing Research, 40, 1011-1025.

Brownlie, E. B., Beitchman, J. H., Escobar, M., Young, A., Atkinson, L., Johnson, C., Wilson,

B., & Douglas, L. (2004). Early language impairment and young adult delinquent and

aggressive behavior. Journal of Child Psychology and Psychiatry and Allied Disciplines,

32, 453-467.

25

Buhrmester, D. (1990). Intimacy of friendship, interpersonal competence, and adjustment during

preadolescence and adolescence. Child Development, 61, 1101-1111.

Buhrmester, D. (1996). Need fulfillment, interpersonal competence and the developmental

contexts of early adolescent friendship. In W. M. Bukowski, A. F. Newcomb, & W. W.

Hartup (Eds.), The company they keep: Friendship in childhood and adolescence (pp.

158-185). New York: Cambridge University Press.

Cain, K., & Oakhill, J. (1996). The nature of the relation between comprehension skill and the

ability to tell a story. British Journal of Developmental Psychology, 14, 187-201.

Cantwell, D. P., & Baker, L. (1987). Clinical significance of childhood communication

disorders: Perspectives from a longitudinal study. Journal of Child Neurology, 2(4), 257-

264.

Catts, H. (1991). Early identification of dyslexia: Evidence from a follow-up study of speech-

language impaired children. Annals of Dyslexia, 41, 163-177.

Catts, H., Fey, M., Tomblin, J., & Zhang, X. (2002). A longitudinal investigation of reading

outcomes in children with language impairments. Journal of Speech, Language and

Hearing Research, 45, 1142-1157.

Clegg, J., Hollis, C., & Rutter, M. (1999). Life Sentence: what happens to children with

developmental language disorders in later life? Bulletin of the Royal College of Speech

and Language Therapists, November, 16-18.

Clegg, J., Hollis, C., Mawhood, L., & Rutter, M. (2005). Developmental language disorders – a

follow-up in later adult life: Cognitive, language and psychosocial outcomes. Journal of

Child Psychology and Psychiatry, 46, 128-149.

Cohen, N. J., Barwick, M., Horodezky, N., Vallance, D. D., & Im, N. (1998). Language,

26

achievement, and cognitive processing in psychiatrically disturbed children with

previously identified and unsuspected language impairments. Journal of Child

Psychology and Psychiatry, 36(6), 865-878.

Conti-Ramsden, G. (2008). Heterogeneity of specific language impairment in adolescent

outcomes. In C. Norbury, B. Tomblin, & D. V. M. Bishop (Eds.), Understanding

developmental language disorders in children: From theory to practice

(pp. 119-133). Hove, UK: Psychology Press.

Conti-Ramsden, G., & Botting, N. (2000). Educational placements for children with specific

language impairments. In D. V. M. Bishop & L. B. Leonard (Eds.), Speech and language

impairments in children: Causes, characteristics, intervention and outcome, pp. 211-

226. Hove, UK: Psychology Press.

Conti-Ramsden, G., & Botting, N. (2004). Social difficulties and victimization in children with

SLI at 11 years of age. Journal of Speech, Language and Hearing Research, 47, 145-161.

Conti-Ramsden, G., & Botting, N. (2008). Emotional health in adolescents with and without a

history of specific language impairment (SLI). Journal of Child Psychology and

Psychiatry, 49, 516-525.

Conti-Ramsden, G., Donlan, C., & Grove, J. (1992). Characteristics of children with specific

language impairment attending language units. European Journal of Disorders of

Communication, 27, 325-342.

Conti-Ramsden, G., & Durkin, K. (2008). Language and independence in adolescents with and

without a history of specific language impairment (SLI). Journal of Speech, Language,

and Hearing Research, 51, 70-83.

27

Conti-Ramsden, G., Durkin, K., Simkin, Z., & Knox, E. (2009). Specific language impairment

and school outcomes. I: Identifying and explaining variability at the end of compulsory

education. International Journal of Language & Communication Disorders, 44(1), 15-35.

Craig, H. K. (1993). Social skills of children with specific language impairment: Peer

relationships. Language, Speech and Hearing Services in Schools, 24, 206-215.

Craig, H. K., & Washington, J. A. (1993). Access behaviors of children with specific language

impairment. Journal of Speech and Hearing Research, 36, 322-337.

Durkin, K., & Conti-Ramsden, G. (2007). Language, social behavior, and the quality of

friendships in adolescents with and without a history of specific language impairment.

Child Development, 78, 1441-1457.

Durkin, K., Conti-Ramsden, G., Walker, A., & Simkin, Z. (2009). Educational and interpersonal

uses of home computers by adolescents with and without specific language impairment.

British Journal of Developmental Psychology, 27, 197-217.

Durkin. K, Simkin, Z., Knox, E., & Conti-Ramsden, G. (2009). Specific language impairment

and school outcomes. II: Educational context, student satisfaction, and post-compulsory

progress. International Journal of Language & Communication Disorders, 44(1), 36-55.

Farmer, M. (2000). Language and social cognition in children with specific language

impairment. Journal of Child Psychology and Psychiatry 41, 627-636.

Fujiki, M., Brinton, B., & Clarke, D. (2002). Emotion regulation in children with specific

language impairment. Language, Speech and Hearing Services in Schools, 33, 102-111.

Fujiki, M., Brinton, B., Isaacson, T., & Summers, C. (2001). Social behaviors of children with

language impairment on the playground: A pilot study. Language, Speech and Hearing

Services in Schools, 32, 101-113.

28

Fujiki, M., Brinton, B., Morgan, M., & Hart, C. H. (1999). Withdrawn and sociable behaviour of

children with language impairment. Language, Speech and Hearing Services in Schools,

30, 183-195.

Fujiki, M., Brinton, B., Robinson, L., & Watson, V. (1997). The ability of children with specific

language impairment to participate in a group decision task. Journal of Childhood

Communication Development, 18, 1-10.

Fujiki, M., Brinton, B., & Todd, C. M. (1996). Social skills of children with specific language

impairment. Language, Speech and Hearing Services in Schools, 27, 195-202.

General Household Survey (2001-2002). Office of National Statistics, Social Survey Division.

Grove, J., Conti-Ramsden, G., & Donlan, C. (1993). Conversational interaction and decision-

making in children with specific language impairment. European Journal of Disorders of

Communication, 28, 141-152.

Guralnick, M. J., Connor, R. T. Hammond, M. A., Gottman, J. M., & Kinnish, K. (1996). The

peer relations of preschool children with communication disorders. Child Development,

67, 471-489.

Hadley, P. A., & Rice, M. L. (1991). Conversational responsiveness of speech- and language-

impaired preschoolers. Journal of Speech and Hearing Research, 34, 1308-1317.

Hartup, W. W. (1996). The company they keep: Friendships and their developmental

significance. Child Development, 67, 1-13.

Hartup, W. W., &. Stevens, N. (1999). Friendships and adaptation across the lifespan. Current

Directions in Psychological Science, 8, 76-79.

29

Howlin, P., Mawhood, L., & Rutter, M. (2000). Autism and developmental receptive language

disorder – a follow-up comparison in early adult life. II: Social, behavioural, and

psychiatric outcomes. Journal of Child Psychology and Psychiatry, 41, 561-578.

Joanisse, M. F., Manis, F. R., Keating, P., & Seidenberg, M.S. (2000). Language deficits in

dyslexic children: speech perception, phonology and morphology. Journal of

Experimental Child Psychology, 71, 30-60.

Knox, E., & Conti-Ramsden, G. (2007). Bullying in young people with a history of specific

language impairment (SLI). Educational and Child Psychology, 24, 130-141.

Ladd, G. W. (1990). Having friends, keeping friends, making friends, and being liked by peers in

the classroom: Predictors of children's early school adjustment? Child Development, 61,

1081-1100.

Ladd, G. W., Kochenderfer, B. J., & Coleman, C. C. (1996). Friendship quality as a predictor of

young children's early school adjustment. Child Development, 67, 1103-1118.

Leonard, L. B. (1987). Is specific language impairment a useful construct? In S. Rosenberg

(Ed.), Advances in applied psycholinguistics, 1, Disorders of first-language development,

pp.1-39. New York: Cambridge University Press.

Leonard, L. B. (1991). Specific language impairment as a clinical category. Language, Speech,

and Hearing Services in Schools, 22, 66-68.

Leonard, L. B. (1998). Children with specific language impairment. Cambridge, Massachusetts:

The MIT Press.

Lindsay, G., & Dockrell, J. (2000). The behaviour and self-esteem of children with specific

speech and language difficulties. British Journal of Educational Psychology, 70, 583 –

601.

30

Marton, K., Abramoff, B., & Rosenzweig, S. (2005). Social cognition and language in children

with specific language impairment (SLI). Journal of Communication Disorders, 38, 143-

162.

McArthur, G. M., Hogben, J. H., Edwards, S. M., Heath, S. M., & Mengler, E. D. (2000). On the

“specifics” of specific reading disability and specific language impairment. Journal of

Child Psychology and Psychiatry, 41, 869-874.

Parker, J. G., & Gottman, J. M. (1989). Social and emotional development in a relational

context: Friendship interaction from early childhood to adolescence. In T. J. Berndt & G.

W. Ladd (Eds.), Peer relationships in child development (pp. 95-131). New York: Wiley.

Redmond, S. M., & Rice, M. L. (1998). The socioemotional behaviors of children with SLI:

Social adaption or social deviance? Journal of Speech, Language and Hearing Research,

41, 688-700.

Semel, E., Wiig, E. H., & Secord, W. (1987). Clinical evaluations of language fundamentals –

revised. U.S.A: The Psychological Corporation.

Shulman, S. (1993). Close relationships and coping behavior in adolescence. Journal of

Adolescence, 16, 267 – 283.

Snowling, M., Bishop, D. V. M., & Stothard, S. E. (2000). Is preschool language impairment a

risk factor for dyslexia in adolescence? Journal of Child Psychology and Psychiatry, 41,

587-600.

Snowling, M. J., Bishop, D. V. M., Stothard, S. E., Chipchase, B., & Kaplan, C. (2006).

Psychosocial outcomes at 15 years of children with a preschool history of speech-

language impairment. Journal of Child Psychology and Psychiatry, 47, 759-765.

31

Snowling, M. J., & Hulme, C. (2008). Reading intervention for children with language learning

difficulties. In C. F. Norbury, J.B. Tomblin, & D.V.M. Bishop (Eds)., Understanding

developmental language disorders: From theory to practice (pp. 175-188). Hove, UK:

Psychology Press.

Steinberg, L., & Morris, A. S. (2001). Adolescent development. Annual Review of Psychology,

52, 83-110.

Stevens, L. J., & Bliss, L. S. (1995). Conflict resolution abilities of children with specific

language impairment and children with normal language. Journal of Speech and Hearing

Research, 38, 599-611.

Tallal, P., Curtiss, S., & Kaplan, R. (1988). The San Diego Longitudinal Study: Evaluating the

outcomes of preschool impairments in language development. In S. G. Berber Mencher

(Ed.), International perspectives on communication disorders (pp. 86-126). Washington,

DC: Gallaudet University Press.

Tallal. P., Dukette, K., & Curtiss, S. (1989). Behavioral/emotional profiles of pre-school

language impaired children. Development and Psychopathology, 1, 51-67.

Tomblin, J.B., Records, N. L., Buckwalter, P., Zhang, X., Smith, E., & O’Brien, M. (1997).

Prevalence of specific language impairment in kindergarten children. Journal of Speech,

Language and Hearing Research, 40, 1245-1260.

Toppelberg, C. O., & Shapiro, T. (2000). Language disorders: A 10-year research update review.

Journal of the American Academy of Child and Adolescent Psychiatry, 39(2), 143-152.

Vallance, D. D., Im, N., & Cohen, N. J. (1999). Discourse deficits associated with psychiatric

disorders and with language impairments in children. Journal of Child Psychology and

Psychiatry and Allied Disciplines, 40, 693-705.

32

Wadman, R., Durkin, K., & Conti-Ramsden, G. (2008). Self-esteem, shyness, and sociability in

adolescents with specific language impairment (SLI). Journal of Speech, Language, and

Hearing Research, 51, 938-952.

Wilson, B., & Risucci, D. (1988). The early identification of developmental language disorders

and the prediction for the acquisition of reading skills. In R. Marsland & M. Marsland

(Eds.), Preschool Prevention of Reading Failure (pp. 187-203). Parkton, MD: York

Press.

33

Table 1

Characteristics of adolescents with SLI and NLD (M, SD) at 16 years

Age Nonverbal

abilities (IQ)

Talking

(Language

expression)

Understanding

(Language

comprehension)

SLI 15;10 (0;5) 84.1 (18.8) 74.1 (11.0) 83.9 (16.9)

NLD 15;11 (0;4) 99.9 (15.8) 97.2 (15.0) 99.5 (13.2)

34

Table 2

Reading abilities in adolescents with SLI at 16 years

Mean (SD) standard score

for age

Percentage falling below

1SD from mean for age

Reading accuracy 83.4 (17.8) 49%

Reading comprehension 75.7 (14.3) 74%

35

Table 3

Anxiety and depression scores (M, SD) for adolescents with SLI and NLD adolescents at

16 years

Anxiety Depression

SLI 10.3 (6.1) 7.6 (5.5)

NLD 7.0 (4.0) 3.7 (4.2)