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• Reflections on 40+ years of clinical

LANGUAGE IMPAIRMENT FROM INFANCY TO ADULTHOOD

and research experience

Bruce TomblinDepartment of Communication Sciences and DisordersUniversity of Iowa, USA

GOALS OF TALK

• Review how I came to be doing outcomes research.

• Outline the origins of the conceptual • Outline the origins of the conceptual model that I have used.

• Summarize the key findings from my research.

• Identify future directions.

A LONG TIME AGO IN A

PLACE FAR, FAR AWAY

• Language Science c. 1994• In psychology, language was

viewed as verbal behavior –a particular kind of human behavior that influenced others (tacts, mands etc).

• Development of language AS AN UNDERGRADUATE

PSYCHOLOGY MAJOR, I DISCOVERED CHILD LANGUAGE VIA AN INTEREST IN

AUTISM.

was largely the accrual of a collection of these behaviors.

• Learning involved general purpose learning systems.

• Abstract mental representations were rarely discussed.

• The notion of child language disorders was just emerging.• Assessment:

• Peabody Picture Vocabulary Test• Illinois Test of Psycholinguistic Ability

• Treatment• Operant principles used in discrete trials imitation

Speech Pathology 1964

p p ptraining.

• Childhood Aphasia –• A disorder of language arising from minimal brain

damage (focal?) with preserved intellect (Morley, McGinnis, Myklebust, Eisenson, Benton).

• Dissent: • Acquired aphasia is very different from childhood aphasia. There

is no direct evidence of brain damage. • Childhood aphasia is a form of mental retardation

• Language Science c. 1994• Linguistics was undergoing a massive

revolution. Chomsky.• Language was an abstract knowledge

system.• Symbols, rules and operations.• It was computational and algorithmic (inputs

to operations and outputs).• Language arose from a special cognitive

t i th i d d l itsystem in the mind - modularity• Language development was beginning to

be seen as a systematic unfolding of this computational system.• Uniformity• Universality• Innateness

• Speech Science• Categorical perception (Haskins

Laboratory): Speech is special

CHILD LANGUAGE MOVING AHEAD

• Speech Pathology and Child Language adopts a Linguistic Perspective.

• Childhood Aphasia becomes Specific Language Impairment (1980)• The term aphasia is dropped• The term aphasia is dropped.• The existence of an isolated impairment of language

becomes accepted.• Language development is viewed as a special

developmental process driven by its own principles.• Children with SLI have a defect in this process and this is why

we say they are impaired.• We will identify the nature of this defect by studying the details

of their language that can serve as markers of the impairment.

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At Iowa I discovered old records of children seen in our clinic with language and speech measures. 18 with Speech and Language Impairment

N l h i Normal hearing Normal nonverbal intelligence Language < 1 SD below mean Verbal IQ> 20 points below PIQ

18 with Speech only.

Contacted parents : obtained permission to get school records and updated the child’s educational status.

Iowa Tests of Basic Skills

Oral language skills, but not speech sound production difficulties, are associated with reading .

Formal Education

•Philosophy of Medicine: Health and Illness are socially defined rather than properties of nature.

•As natural phenomena, individual differences are all

1983 Symposium on Research in Child Language Disorders

pof equal value.

•The individual differences are not inherently normal or disordered.

•Social values dictate states of health and Illness

“If this is true then disorder isn’t real”

IndividualDifferences

In Language

ORIGINS OF DEVELOPMENTAL LANGUAGE DISORDER: Individual differences

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In nature individual differences of any type are neither “good” nor “bad”.

In modern biology, species variation is essential for survival and evolution.

Some forms of variation are better suited than others. Which variation serves these functions can only be known

after the fact.

ORIGINS OF DEVELOPMENTAL LANGUAGE DISORDER

IndividualDifferencesIn Language

Soci

al V

alues

+

-

+

+

-

-

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•Social groups form value systems (norms) that apply to the behavior of their members.

•These value systems establish what are “good” and “bad” forms of individual behavioral differences.

•Disordered (Ill health) forms of behavior reflect limitations in the person’s ability to accomplish socially expected and valued activities.

•Disorder or illness is an assigned status that reflects a relationship between the individual and the community.

•Language disorder is not found within the child but rather between the child and the functions served by language.

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ORIGINS OF DEVELOPMENTAL LANGUAGE DISORDER

IndividualDifferencesIn Language

ocia

l Val

ues-

+

+

-

-viro

nmen

tal

Sen

sory

Bio

logi

cal Cognitive

Neural Connectivity

Neuronal

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Individual differences do arise from systematic causal systems. The function of these systems are necessary but not sufficient for

explaining ill health. S

o

+En Neuronal

Genetic

UNDERSTANDING LANGUAGE DISORDER

• Developmental language disorder arises out of individual differences

• Societies may carve up these individual differences in different ways and is not necessarily a distinct type or form of these differences.

• The outcomes of individual differences in language are not by-g g yproducts of language disorder, but rather are grounds upon which we determine when language disorder occurs.

• An understanding of language disorder requires examining the pathways that run between social values and individual differences in speech and language.

• Direct pathway – values are applied directly on behavior

• Indirect pathway – values are applied indirectly via relationships between speech and language and functions that are valued.

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Individual DifferencesIn Speech and Language

Phonology/Speech Production

Pragmatics

Grammar

Semantics

Phonological Processing

Soc

ial V

alue

s

+

-

+

+

-

-

Academics

Friendships

Well Being

ARE VALUES PASSED

DIRECTLY ON

• 30 min language samples from 35 children between 36 and 78 months . (4 2 minute samples fro m each child).

• Samples played to 4 young adult listeners who were told these were children between 41/2 and 51/2 years old

JSHR, 1990

NTO INDIVIDUAL DIFFERENCES IN

LANGUAGE?

these were children between 41/2 and 51/2 years old.

• Child was rated (7 point scale) on 24 adjective pairs to form a semantic differential. superior/inferior; above average/below average; good/bad; big/small; relaxed/tense; bold/assertave; fast/slow; active/passive; mature/immature; dominant/submissive.

• Three factors:

• Dynamism

• Maturity (cognitive developmental status)

• Social appeal

ARE INDIVIDUAL DIFFERENCES IN SPEECH AND LANGUAGE ASSOCIATED WITH LISTENER

JUDGMENTS?

Dynamism R2

Conversational Participation .06+ Phonological Accuracy .10

MaturityPhonological Accuracy .36+Conversational Participantion .42+Speaking Rate .44+ Adherence to Gramm. .45

Social AppealConversational Participation .13+Dysfluency .16

INDIRECT EVIDENCE OF THE DIRECT EVALUATION OF SPEECH

• 1992-1995 Conducted a study of the prevalence of SLI in kindergarten children.• Screened 7000+ kindergarten children for poor

language.• Tested speech and language abilities in children • Tested speech and language abilities in children

who failed the screen (901) or passed screen (1,108).

• 10% of diagnosed children had received or were receiving speech-language intervention.

• Diagnosed language disorder based on EpiSLIstandard (2/5 subscores <10th percentile)

• Diagnosed speech disorder based on TOLD-2:P Word Artic (<-1.14 SD).

LSHSS, 2000

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•Poor speech sound skill is a stronger predictor of receipt of services than poor language

•Being male irrespective of your speech or language increases your likelihood of identification.

Social Values are Directly Applied to

Some Aspects of Communication but

O h

• The social values found in Western European cultures do seem to directly apply to speech behaviors.• Communication is a marker of cultural and

social backgrounds.• It is possible that we are attuned to speech

variation.• Pragmatic skills are also very likely to be

di tl li k d t i l lnot Others directly linked to social value.• Social values are less sensitive to

language differences (content and form).

• Does this mean that language variation unless large is not important?• Perhaps language variation inherits its

evaluation?

Individual DifferencesIn Speech and Language

Phonology/Speech Production

Pragmatics

Grammar ocia

l Val

ues-

+

+

-

-

How Can we Look at Pathways of Indirect Evaluation?

Grammar

Semantics

Phonological Processing

S

+

Academics

Friendships

Well Being

Social Valued Outcome as Competence

Fulfillment of social roles represents competence and failure represents incompetence (Masten et al. 1999)

Socially defined competence expectations

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Socially defined competence expectations change over development (Zigler & Gllick, 1986)

Earlier competence persists Earlier competence can influence later

competence in other domains (cascade) To the extent that language influences these

outcomes it will inherit their value.

COMMUNICATION AND COMPETENCE

Language & Communication

Academic

SocialIndependenceConduct

Academic Achievement

Close Friendships

Emerging Independence

Conduct

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Pre-school Years AdolescenceChildhood

Independence

Academic Achievement Friendships Conduct

ConductT i l C t l

Iowa Longitudinal Study

NLI SLI103 102

Typical Control372

N=577

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Mean Age 8.0 9.9

N= 604 575604 503

13.9

Age Range

5.9

7.1-9.0 9.1-10.9 13.1-15.4

541

15.8

14.9-17.4Age Range

Iowa Longitudinal Study

Measures Obtained• Spoken Language• Reading• Academic Perfomance• Psychosocial• Cognitive• DNA

ACADEMIC OUTCOMES

• Reading Outcomes• Parent and Teacher Rating of Performance

G d R t ti• Grade Retention• Need for Curriculum Adaptation and Special

Education

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LANGUAGE & READING CONNECTIONS

Few dispute the strong relationships between language and reading.Reading requires several coordinated skills, but most agree that functional reading comprises g g preading comprehension.Simple view of reading comprehension:

Reading comprehension=word reading*(listening) comprehension

How do children with poor language at school entry do with regard to reading?

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RATES OF POOR READING COMPREHENSION

High levels of poor reading are found persistently at high levels in children who enter school with poor spoken languageR t f 40

50

60

70

80

SLI NLI Normal

Rates of poor comprehension are 5 to 9 times as great as in children with normal languageRisk for poor comprehension is high even when non-verbal IQ is controlled.

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0

10

20

30

40

8 years 10 years 14 years 16 years

Reading < -1 SD

READING LESS THAN GRADE 5 (11 YEARS AT 16

22.8 %

29

4.6 % PIQ Co-variate

IS EARLY SPEECH DISORDER ASSOCIATED WITH LATER RD?

253035404550

in 4

thG

rad

e

Recall in Hall and Tomblin the children with language and articulation problems had poorer reading than the artic only

05

10152025

ImpairedNormal

Perc

ent R

D

Status in Kindergarten

only.

Reading is believed to be tied to phonological processing and so we might expect SD to result in RD.

In fact, SD has only a weak effect.

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DOES LANGUAGE CONTRIBUTE TO ACADEMIC SUCCESS BEYOND READING?

• Learning to read is a important academic accomplishment.

• Reading also becomes an important tool for learning.

• However the role of language in classroom • However, the role of language in classroom learning is likely to go beyond reading – particularly if reading is viewed as word decoding.

• Reading comprehension at advanced levels is essentially equivalent to listening comprehension.

• Some and perhaps a great deal of learning is via listening.

WORD READING AND LISTENING COMPREHENSION CONTRIBUTION TO

READING COMPREHENSION

0 50.60.70.80.9

Word Reading

Listening

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00.10.20.30.40.5

2nd 4th 8th 10th

ListeningComprehension

Sum

Par

tial r

2

Reading ComprehensionWRMT Passage CompGORTDAB

Word ReadingWRMT Word IDWRMT Word Attack

Listening ComprehensionCELF-3

ROLE OF SPOKEN LANGUAGE AND READING IN RATED SCHOOL

PERFORMANCETeacher rating of reading

Teacher rating of writing

Teacher ratingC

.97

.92

88R di C h i 34

Word Recognition(2nd Grade)

.34

.64.25

Teacher rating of math

Parent rating of language, reading

Parent rating of Math

ClassroomPerformance

.88

.73

.63

Reading Comprehension(2nd Grade)

Language(kindergarten)

.34

.23.34

CFI: .95TLI: .97

.54

.31

SUMMING UP

• Social values need to be incorporated into our research and clinical thinking as these define health.

• Individual differences in some aspects of i ti di l d di tl d th communication are disvalued directly and others

indirectly.• The importance of communication as a tool for

learning is clear.• The role of listening comprehension in the classroom

remains under appreciated and a rich area for more research.

SOCIAL DEVELOPMENT

Social Participation Youth Self-Report (YSR)

CBCL Parent

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CBCL Social Skills Rating System Perceived Adequacy of Social

Relationships UCLA Loneliness Scale (Russel, 1996)

Parent

SOCIAL RELATIONSHIPS

• Both SLI and GD participated less than typical

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comparison grp. (η2=.05)

• Only GD were more lonely (affiliation) than comparison (η2=.03).

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SUBJECTIVE WELL-BEING

Modified Self Perception Scale for Adolescents (Harter, 1988)Mental CompetenceSelf WorthSocial Appearance

37Afasic Symposium 2007

Social Appearance

Satisfaction with Life (Pavot & Diener, 1993)

Positive Affect/DepressionYSR

HARTER SCALING METHOD

Some students get kind of lonely because they don’t have a close friend to share things with.

Other students don’t usually get too lonely because they do have a close friend to share things with.

1 32 4

Mental CompetenceConfident in schoolwork

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Confident in schoolworkLike writing papersSmart Do well in school workWant to answer teacher’s questions

Global Self EsteemSatisfied with selfDon’t get lonely Get a long with parentsLike themselves

Social AppearanceLike physical appearanceRomantic relationshipGood at video gamesGood dancer

26 items

3 Principal Components

SUBJECTIVE WELL-BEING

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SATISFACTION WITH LIFE

“I am satisfied with life”“If I could live my life over, I would change almost nothing”

1 2 3 4 5

40Afasic Symposium 2007

SUMMARY OF RESEARCH

Individual differences in speech and language at the start of school have consequences.Speech impairments are able to receive direct evaluation by listeners that lead to negative social value (stigma)social value (stigma).Poor language skills place children at risk for socially significant difficulties via their indirect effects on important life functions particularly education.Language disorders may be like high blood pressure. Silent killers.

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