Attachment in toddlers with autism and other developmental disorders

Attachment was assessed in toddlers with Autistic Disorder (n=20), Pervasive Developmental Disorder (n=14), Mental Retardation (n=12), Language Development Disorder (n=16), and a non-clinical comparison group (n=18), using the Strange Situation Procedure (SSP). Children in the clinical groups were more often disorganized and less often securely attached. Severity of autism was associated with more attachment insecurity, and lower developmental level increased the chance for disorganized attachment. Attachment disorganization was related to increased heart rate during the SSP. Controlling for basal cortisol and developmental level, more autistic symptoms predicted lower cortisol responses to the SSP. The findings support the importance of disorganized attachment for children with autism.

Network model of decreased context utilization in autism spectrum disorder

Individuals with autism spectrum disorders (ASD) demonstrate impaired utilization of context, which allows for superior performance on the "false memory" task. We report the application of a simplified parallel distributed processing model of context utilization to the false memory task. For individuals without ASD, experiments support a model wherein presentation of one word, e.g., ''apple,'' strongly activates the neighboring nodes of closely related words such as ''fruit,'' ''tree,'' whereas in ASD these neighboring nodes are relatively less activated. We demonstrate this model to be consistent with the superior performance on recognition testing on the false memory test, but not on free recall. This may have an anatomic basis in diminished hippocampal neuronal arborization and the abnormal minicolumnar pathology in ASD.

Comparison of Language Skills of Adjudicated and Nonadjudicated Adolescent Males and Females

Purpose

This study attempted to determine whether there were any differences or similarities in the basic cognitive and language skills of 4 groups of adolescents: adjudicated (a judge’s decision to establish responsibility for a delinquent act) and nonadjudicated male and females.

Method

The 4 groups of adolescents were 18 adjudicated females, 18 nonadjudicated females, 14 adjudicated males, and 14 nonadjudicated males. They were evaluated using the Kaufman Brief Intelligence Test (K–BIT; A. S. Kaufman & N. L. Kaufman, 1990) as a screener for intelligence and the Clinical Evaluation of Language Fundamentals—3 (CELF–3; E. Semel, E. Wiig, & W. Secord, 1995) as a screener for language skills.

Results

No gender differences were found between the groups for either the K–BIT or the CELF–3. All groups scored within normal limits on the K–BIT subtests, but lower on the vocabulary portion of the K–BIT compared to the matrices (nonverbal) portion. There were differences found between adjudicated and nonadjudicated groups on the CELF–3, with the adjudicated groups having lower scores.

Implications

As the majority of adjudicated adolescents had not been previously identified as having difficulties with language abilities, this population could benefit from early assessment. Also, children who are at risk for incarceration should be screened for possible language deficits that could contribute to the many difficulties experienced by adolescents.

Language development and mild-to-moderate hearing loss: does language normalize with age?

PURPOSE

The authors' purpose was to explore the nature of the link between hearing loss (HL) and language impairment in adolescents with mild-to-moderate hearing loss (MMHL). Does language performance (generally or in certain areas) normalize at adolescence?

METHOD

The language skills of 19 French-speaking adolescents (ages 11-15) with moderate or mild sensorineural HL were evaluated via a series of tests assessing oral and written language, including an experimental probe, and compared with typically developing adolescents and adolescents with specific language impairment (SLI).

RESULTS

Language disorders were found, notably in the areas of phonology and grammar, in more than half the adolescents with MMHL; affected domains and error patterns were identical to those found in adolescents with SLI. Language scores of the adolescents with MMHL were significantly linked with degree of HL, a correlation not generally found in studies of children with MMHL.

CONCLUSION

Normalization of language performance does not generalize at adolescence in the context of MMHL. The fact that an effect of the severity of HL was found only after childhood might be because linguistic development is basically complete at adolescence. Prior to this time, this effect could be obscured by developmental rhythms that vary from child to child.

Aggression and withdrawal related behavior within conflict management progression in preschool boys with language impairment

OBJECTIVE

This study examined conflict behavior in naturalistic preschool settings to better understand the role of non-affiliative behavior and language in conflict management.

METHOD

Free-play at preschool was filmed among 20 boys with typically developing language (TL) and among 11 boys with Language Impairment (LI); the boys 4-7 years old. Conflict behavior was coded and analyzed with a validated system. Post-conflict non-affiliative behavior (aggression and withdrawal) displays, and the links between the displays and reconciliation (i.e., former opponents exchange friendly behavioral shortly after conflict termination) was examined.

RESULTS

Group comparisons revealed boys with LI displayed aggression in a smaller share of conflicts, but exhibited [Symbol: see text]active' withdrawal (left the room), in a larger conflict share. Boys with TL overcame aggression (more common TL behavior) and after reconciled, to a greater extent than the boys with LI after active withdrawal (more common LI behavior). Also, after reciprocal or only verbal aggression, boys with LI reconciled to a lesser extent than boys with TL.

CONCLUSIONS

The boys with LI demonstrated difficulties confronting conflict management, as well as concluding emotionally heightened and aggressive behavioral turns.

Language acquisition with limited input: Romanian institution and foster care

PURPOSE

To provide the first detailed information about native language abilities of children who are or had been institutionalized.

METHOD

The language of ten 30-month-old children raised in Romanian orphanages was compared with that of 30 chronological-age-matched peers: 10 children who had moved recently from orphanages to foster care, 10 children in foster families for at least 1 year, and 10 children raised in their biological families. Ten language measures were obtained from communication during play and from parent/caregiver report.

RESULTS

Children who were institutionalized and children in foster care for a brief time showed substantial language delays, with some of these children not yet producing intelligible words. Children in foster care for at least 1 year approximated the expressive output and receptive language of children who had never been institutionalized; however, they showed lower expressive grammatical abilities. Within the group of children who were institutionalized, the presence of a preferred caregiver and a measure of development, greater height, were associated with greater language output. Although children in orphanages produced fewer complex forms than children in biological families, there were no systematic qualitative differences in language structure across groups.

CONCLUSION

Foster care facilitated language growth after substantial language delays associated with institutionalization.

Social cognition and externalizing psychopathology: an investigation of the mediating role of language

The present study integrates findings from three lines of research on the association of social cognition and externalizing psychopathology, language and externalizing psychopathology, and social cognition and language functioning using Structural Equation Modeling (SEM). To date these associations have been examined in pairs. A sample of 354 clinic-referred children (aged 7 to 14 years) recruited from a children's mental health centre were tested on measures of language, social cognition, working memory, and child psychopathology. We compared a hypothesized model presenting language functioning as a mediator of the association between social cognition and externalizing psychopathology to a model presenting the independent contribution of language and social cognition to externalizing psychopathology. As hypothesized, we found that the mediation model fits the data better than the alternative model. Our findings have implications for developing and modifying intervention techniques for children with dual language and externalizing psychopathology.

Narrative in adolescent specific language impairment (SLI): a comparison with peers across two different narrative genres

BACKGROUND

Narrative may provide a useful way in which to assess the language ability of adolescents with specific language impairment and may be more ecologically valid than standardized tests. However, the language of this age group is seldom studied and, furthermore, the effect of narrative genre has not been explored in detail.

METHODS & PROCEDURES

A total of 99 typically developing adolescents and 19 peers with specific language impairment were given two different types of narrative task: a story-telling condition and a conversational condition. Four areas of narrative (productivity, syntactic complexity, syntactic errors and performance) were assessed.

OUTCOMES & RESULTS

The group with specific language impairment was poorer on most aspects of narrative confirming recent research that specific language impairment is a long-term disorder. A number of measures also showed interactions between group and genre, with story-telling proving to be a disproportionately more difficult task for the specific language impairment group. Error analysis also suggested that the specific language impairment group was making qualitatively different errors to the typically developing group, even within a genre.

CONCLUSIONS

Adolescents with specific language impairment are not only poorer at both types of narrative than peers, but also show different patterns of competence and error, and require more support from the narrative-partner.

CLINICAL IMPLICATIONS

Assessments of adolescents are less frequent than at younger ages. This is partly because of the sparsity of tests available in this age range. Qualitative analysis of narrative might prove a useful alternative. The findings suggest that in every-day conversation, young people with specific language impairment manage their difficulties more discreetly and this might make them harder to identify in a mainstream setting.

On-line processing of wh-questions in children with G-SLI and typically developing children

BACKGROUND

The computational grammatical complexity (CGC) hypothesis claims that children with G(rammatical)-specific language impairment (SLI) have a domain-specific deficit in the computational system affecting syntactic dependencies involving 'movement'. One type of such syntactic dependencies is filler-gap dependencies. In contrast, the Generalized Slowing Hypothesis claims that SLI children have a domain-general deficit affecting processing speed and capacity.

AIMS

To test contrasting accounts of SLI we investigate processing of syntactic (filler-gap) dependencies in wh-questions.

METHODS & PROCEDURES

Fourteen 10;2-17;2 G-SLI children, 14 age-matched and 17 vocabulary-matched controls were studied using the cross-modal picture-priming paradigm.

OUTCOMES & RESULTS

G-SLI children's processing speed was significantly slower than the age controls, but not younger vocabulary controls. The G-SLI children and vocabulary controls did not differ on memory span. However, the typically developing and G-SLI children showed a qualitatively different processing pattern. The age and vocabulary controls showed priming at the gap, indicating that they process wh-questions through syntactic filler-gap dependencies. In contrast, G-SLI children showed priming only at the verb.

CONCLUSIONS

The findings indicate that G-SLI children fail to establish reliably a syntactic filler-gap dependency and instead interpret wh-questions via lexical-thematic information. These data challenge the Generalized Slowing Hypothesis account, but support the CGC hypothesis, according to which G-SLI children have a particular deficit in the computational system affecting syntactic dependencies involving 'movement'. As effective remediation often depends on aetiological insight, the discovery of the nature of the syntactic deficit, along side a possible compensatory use of semantics to facilitate sentence processing, can be used to direct therapy. However, the therapeutic strategy to be used, and whether such similar strengths and weaknesses within the language system are found in other SLI subgroups are empirical issues that warrant further research.

Answering contextually demanding questions: pragmatic errors produced by children with Asperger syndrome or high-functioning autism

This study examined irrelevant/incorrect answers produced by children with Asperger syndrome or high-functioning autism (7-9-year-olds and 10-12-year-olds) and normally developing children (7-9-year-olds). The errors produced were divided into three types: in Type 1, the child answered the original question incorrectly, in Type 2, the child gave a correct answer, but when asked a follow-up question, he/she explained the answer incorrectly, and in Type 3, the child first gave a correct answer or explanation, but continued answering, which ultimately led to an irrelevant answer. Analyses of Type 1 and 2 errors indicated that all the children tried to utilize contextual information, albeit incorrectly. Analyses of Type 3 errors showed that topic drifts were almost non-existent in the control group, but common in the clinical group, suggesting that these children had difficulties in stopping processing after deriving a relevant answer.

LEARNING OUTCOMES

The reader becomes aware of the different instances which may lead to the irrelevance of answers and get knowledge about features of answers of children with AS/HFA.

Language, Social Behavior, and the Quality of Friendships in Adolescents With and Without a History of Specific Language Impairment

Language is drawn on extensively in friendships but has received scant attention in the developmental literature. This study compared friendship quality in 16-year-old adolescents with and without specific language impairment (SLI), testing the extent it is predicted by individual differences in social behaviors and language ability. Participants were 120 adolescents with SLI and 118 typically developing (TD) adolescents. After considering the effects of nonverbal IQ and prosocial and difficult behavior, language measures were found to be associated with friendship quality. The TD participants enjoyed normal friendships, whereas the participants with SLI were more likely to exhibit poorer quality (although 60% experienced good quality of friendships). Longitudinal analyses identified early language difficulties as predictive of poorer friendship quality in adolescence.

Verbal and gestural communication in children with bilateral perisylvian polymicrogyria

We assessed intelligence and receptive and expressive language skills in 6 children, ages 7 years 9 months to 12 years 4 months, with bilateral perisylvian polymicrogyria of variable extent and with dysarthria of different severity. In view of the recent findings of a close relationship between word and gesture, we also examined the communicative use of gesture. We found that mental retardation was related to the extent of cortical malformation; lexical comprehension, but not morphosyntactic comprehension, and verbal production were more compromised than expected from nonverbal intellectual abilities; lack of verbal language was not compensated by the use of referential gestures. Results are discussed suggesting that compromised verbal and gestural communication in bilateral perisylvian polymicrogyria are not due simply to mental retardation and/or dysarthria but also to dysfunction of Sylvian fissure areas concerned with the totality of language processing.

Parents' and speech and language therapists' explanatory models of language development, language delay and intervention

BACKGROUND

Parental and speech and language therapist (SLT) explanatory models may affect engagement with speech and language therapy, but there has been dearth of research in this area. This study investigated parents' and SLTs' views about language development, delay and intervention in pre-school children with language delay.

AIMS

The aims were to describe, explore and explain the thoughts, understandings, perceptions, beliefs, knowledge and feelings held by: a group of parents from East Manchester, UK, whose pre-school children had been referred with suspected language delay; and SLTs working in the same area, in relation to language development, language delay and language intervention.

METHODS & PROCEDURES

A total of 24 unstructured interviews were carried out: 15 with parents whose children had been referred for speech and language therapy and nine with SLTs who worked with pre-school children. The interviews were transcribed verbatim and coded using Atlas/ti. The data were analysed, subjected to respondent validation, and grounded theories and principled descriptions developed to explain and describe parents' and SLTs' beliefs and views.

OUTCOMES & RESULTS

Parent and SLT data are presented separately. There are commonalities and differences between the parents and the SLTs. Both groups believe that language development and delay are influenced by both external and internal factors. Parents give more weight to the role of gender, imitation and personality and value television and videos, whereas the SLTs value the 'right environment' and listening skills and consider that health/disability and socio-economic factors are important. Parents see themselves as experts on their child and have varied ideas about the role of SLTs, which do not always accord with SLTs' views. The parents and SLTs differ in their views of the roles of imitation and play in intervention. Parents typically try strategies before seeing an SLT.

CONCLUSIONS

These data suggest that parents' ideas vary and that, although parents and SLTs may share some views, there are some important differences. These views have implications for the provision of appropriate services. Although this is a small sample from one group in the UK, the results indicate the need to investigate the views of other groups of parents.

Assertive and responsive conversational skills of Italian-speaking late talkers

BACKGROUND

Previous research on the pragmatic abilities of late talkers at 24 months of age indicates that they have difficulties initiating conversational interactions, but possess intact responsiveness skills. This study uses a parent-administered questionnaire for evaluating the conversational skills of late talkers and suggesting pragmatic intervention goals.

AIM

To examine the conversational assertiveness and responsiveness of late talkers at 2 years of age.

METHODS & PROCEDURES

A parent report measure, The Social Conversational Skills Rating Scale-Italian version, was administered to 30 parents of late talkers, 30 parents of typically developing children matched for age, and 30 parents of younger, typically developing children matched for vocabulary size.

OUTCOMES & RESULTS

The late talkers received significantly lower ratings for both assertiveness and responsiveness in comparison with their age-matched peers. They did not differ significantly from the younger, vocabulary-matched group. Assertiveness and responsiveness mean ratings were positively correlated with vocabulary size for the age-matched group, but not for either of the other two groups.

CONCLUSIONS

This study confirms a delay in the development of late talkers' social-conversational skills. An investigation of individual profiles suggests that some late talkers may require goals for vocabulary development as well as independent goals for developing pragmatic skills.

[Critical factors for subjective burden of mothers of children with developmental language disorders]

BACKGROUND

In earlier studies, it was found that mothers of children with developmental language disorders had a higher incidence of anxiety and depression in comparison to the normal population. This study concentrated on the following questions: is the perceived stress, anxiety and depression of mothers with children with developmental language disorders higher than in the normal population, even for those mothers who are not exposed to any further stressors? and what environmental factors play an important role in the mental health of the mothers?

MATERIALS AND METHODS

A total of 90 mothers (aged 32.9+/-4.7 years) of preschoolers diagnosed with a developmental language disorder, but with otherwise normal development, participated in the study. The mental health of the mothers was assessed using the Perceived Stress Scale (PSS) and the German version of the Hospital Anxiety and Depression Scale (HASD-D). Environmental factors were captured by a structured anamnestic procedure. Predictors of mental health were determined using multivariate regression analysis.

RESULTS

The entire sample demonstrated significant levels of stress, anxiety and depression. In comparison to the standardized values, those mothers of children with developmental language disorders who were not exposed to any further stressors, were also shown to have significantly higher rates of stress and depression on the scales used, although not significantly higher levels of anxiety. A significant predictor of positive overall mental health of the mothers was the extent of adequate support in child rearing.

CONCLUSIONS

Health professionals dealing with children with developmental language disorders must reckon with a considerable number of mothers whose mental health is negatively affected. When treating a child with a developmental language disorder, measures to improve the mother's state of well-being should be considered, including counseling and self-help groups.

Parent-Rated Anxiety Symptoms in Children with Pervasive Developmental Disorders: Frequency and Association with Core Autism Symptoms and Cognitive Functioning

BACKGROUND

In addition to the core symptoms, children with Pervasive Developmental Disorders (PDD) often exhibit other problem behaviors such as aggression, hyperactivity, and anxiety, which can contribute to overall impairment and, therefore, become the focus of clinical attention. Limited data are available on the prevalence of anxiety in these children. We examined frequency and correlates of parent-rated anxiety symptoms in a large sample of children with PDD.

METHODS

The goals of this study were to examine the frequency and correlates of parent-rated anxiety symptoms in a sample of 171 medication-free children with PDD who participated in two NIH-funded medication trials. Twenty items of the Child and Adolescent Symptom Inventory (CASI) were used to measure anxiety.

RESULTS

Forty three percent of the total sample met screening cut-off criteria for at least one anxiety disorder. Higher levels of anxiety on the 20-item CASI scale were associated with higher IQ, the presence of functional language use, and with higher levels of stereotyped behaviors. In children with higher IQ, anxiety was also associated with greater impairment in social reciprocity.

CONCLUSION

Anxiety is common in PDD and warrants consideration in clinical evaluation and treatment planning. This study suggests that parent ratings could be a useful source of information about anxiety symptoms in this population. Some anxiety symptoms such as phobic and social anxiety may be closer to core symptoms of PDD. Further efforts to validate tools to ascertain anxiety are needed, as are studies to empirically test approaches to treat anxiety in PDD.

Language delay and behavioral/emotional problems in toddlers: findings from two developmental clinics

PURPOSE

The association between language delay and behavior problems in toddlers was examined in 2 studies, 1 conducted in a developmental clinic in New Jersey (Study 1; N = 83) and the other conducted in a developmental clinic in New York (Study 2; N = 103).

METHOD

In both clinics, parents of 18- to 35-month-olds completed the Language Development Survey (LDS) and the Child Behavior Checklist/1.5-5 (CBCL). In Study 2, the Preschool Language Scale-Fourth Edition (PLS-4) was also administered. Neurodevelopmental delay (ND) and pervasive developmental disorder (PDD) symptoms were also assessed in both studies but were done so using different measures.

RESULTS

In Study 1, LDS Vocabulary score and CBCL Total Problems, Internalizing, and Withdrawn scores were significantly correlated. However, when children with ND and/or suspected PDD were excluded, only the correlation between LDS Vocabulary and Withdrawn remained significant. In Study 2, only the correlation between LDS Vocabulary and Withdrawn approached significance. Children delayed in language on the PLS-4 had higher CBCL scores than typically developing toddlers only on the CBCL Withdrawn syndrome.

CONCLUSION

Significant associations between language delays and behavior problems were not found in 2 samples of 18- to 35-month-olds when children with ND and PDD were excluded, except that toddlers with language delays appeared to show elevated social withdrawal relative to typically developing toddlers.

Communicative Competence and Metalinguistic Ability: Performance by Children and Adults with Autism Spectrum Disorder

The Test of Language Competence-Expanded Edition (TLC-E) was administered to children and adults with a diagnosis of autism spectrum disorder (ASD). Relative to controls, those with ASD were less competent on a range of TLC-E tasks. No differences were found for either child or adult ASD groups on any of the TLC-E measures when re-classified as Asperger syndrome (AS) and high functioning autism (HFA) using DSM-IV language criterion. Hierarchical cluster analyses of individuals with ASD identified subgroups within the spectrum. The use of developmental language history as an identifying marker in autism is questioned. The findings suggest that comprehensive language assessments on individuals with ASD can provide clinically relevant information regarding the heterogeneity of language skills within the autistic spectrum.

Understanding alexithymia and language skills in children: implications for assessment and intervention

PURPOSE

This article reviews the construct of alexithymia and its relationship to language impairment.

METHOD

The article includes a review of the literature on emotional competence, trauma effects, alexithymia, and language impairment; summarizes tools to assess alexithymia; and provides an intervention framework.

IMPLICATIONS

Understanding the relationship of emotional competence and language impairment may provide a new perspective for speech-language pathologists who are serving children with language and socioemotional impairments.

Child maltreatment: a global issue

PURPOSE

This article explains why children with speech and language impairments are at increased risk for having experienced abuse, neglect, and trauma and how maltreatment may vary across cultures.

METHOD

International literature on maltreatment is reviewed in order to provide frameworks for identifying what constitutes maltreatment across cultures; how cultural variations in discipline practices impact maltreatment; and professionals' roles in treatment when they encounter children who have experienced abuse, neglect, or trauma.

CONCLUSION

Speech-language pathologists and audiologists are required to document and report any instance of suspected child abuse. To intervene effectively with children and families from diverse cultures who experience maltreatment, professionals must understand when a practice causes harm and be able to modify childrearing practices in culturally acceptable ways.

Collaborative services: children experiencing neglect and the side effects of prenatal alcohol exposure

PURPOSE

The purpose of this article is to provide critical knowledge regarding children who are served by the child welfare system and how these children's specialized needs affect speech-language services. Specifically, the structure of social services system models is presented, with an emphasis on the cultural and systemic interactions between service providers and families. In addition, the role of special education for children who have experienced abuse, neglect, and prenatal drug or alcohol exposure is presented, with an emphasis on social service and special education legal issues.

METHOD

This article provides a critical analysis of the research literature to date regarding effective tools for providing collaborative intervention to children who are experiencing fetal alcohol syndrome disorder or abuse and/or neglect.

CLINICAL IMPLICATIONS

This article provides suggestions about the collaborative roles that speech-language pathologists should integrate into treatment milieu when delivering therapy to children with histories of abuse, neglect, and prenatal drug or alcohol exposure.

Processes of language acquisition in children with autism: evidence from preferential looking

Two language acquisition processes (comprehension preceding production of word order, the noun bias) were examined in 2- and 3-year-old children (n=10) with autistic spectrum disorder and in typically developing 21-month-olds (n=13). Intermodal preferential looking was used to assess comprehension of subject-verb-object word order and the tendency to map novel words onto objects rather than actions. Spontaneous speech samples were also collected. Results demonstrated significant comprehension of word order in both groups well before production. Moreover, children in both groups consistently showed the noun bias. Comprehension preceding production and the noun bias appear to be robust processes of language acquisition, observable in both typical and language-impaired populations.

Children With Autism Illuminate the Role of Social Intention in Word Learning

To what extent do children with autism (AD) versus typically developing children (TD) rely on attentional and intentional cues to learn words? Four experiments compared 17 AD children (M age=5.08 years) with 17 language- and 17 mental-age-matched TD children (M ages=2.57 and 3.12 years, respectively) on nonverbal enactment and word-learning tasks. Results revealed variability in all groups, but particularly within the AD group. Performance on intention tasks was the most powerful predictor of vocabulary in the AD group but not in the TD groups. These findings suggest that word learning cannot be explained exclusively by either attentional or intentional processes, and they provide evidence of a special role for intentional understanding in the vocabulary development of AD children.

Severe receptive language disorder in childhood--familial aspects and long-term outcomes: results from a Scottish study

BACKGROUND AND AIMS

Little is known about the familial characteristics of children with severe receptive specific language impairment (SLI). Affected children are more likely to have long-term problems than those with expressive SLI but to date they have only been described as small cohorts within SLI populations. We therefore aimed to describe the clinical and familial characteristics of severe receptive SLI as defined by a rigorous phenotype and to establish whether non-word repetition showed a relationship with language impairment in these families.

METHODS

Cross-sectional study of children who met ICD-10 (F80.2) criteria for receptive SLI at school entry, their siblings and genetic parents with standardised measures of language and non-verbal IQ, phonological auditory memory and speech sound inventory.

RESULTS

At a mean of 6 years after school entry with a severe receptive SLI, the 58 participants had a normal mean and standard deviation non-verbal IQ, but only 3% (two) had attained language measures in the normal range. One third still had severe receptive language impairment. One third of siblings not known to be affected had language levels outside the normal range. Phonological auditory memory was impaired in most family members.

CONCLUSION

Severe receptive SLI is nearly always associated with an equally severe reduction in expressive language skills. Language impairment in siblings may go undetected and yet they are at high risk. Family members had weak phonological auditory memory skills, suggesting that this could be a marker for language acquisition difficulties. Receptive SLI rarely resolves and trials of therapy are urgently needed.