Reviewing the link between language abilities and peer relations in children with developmental language disorder: The importance of children's own perspectives

BACKGROUND AND AIMS

Children with developmental language disorder (DLD) are at risk of difficulties in their friendships and peer relations. The present review explores how research directly involving children with DLD can inform our understanding of peer relations in this group, and how research insights may change according to the nature of their involvement in the studies. We further examine how these findings might shape current theoretical understandings of the links between language impairment and peer relations.

METHODS

An integrative review methodology was used in order to identify relevant studies and synthesise the findings. A structured database search was carried out using the qualitative PICo framework; Population = 4-12-year-old children with DLD, phenomenon of Interest = peer relations, Context = research studies directly including children. After screening, 52 studies were included in a narrative research synthesis.Main contribution: We identified six main types of study that directly included children with DLD; interview, sociometric, self-report, task-based, naturalistic observation and staged observation. Interview-based studies were the most likely to use a meaningful participatory approach. Indications of good practices for participation included reporting on involvement practices, seeking child assent, adapting materials and language used, using visual supports, using child-preferred communication methods and using art-based approaches. Findings from the narrative synthesis of studies highlight the importance of friendships to quality of life, and the role of pragmatic language skills and self-perceptions in building friendships.

CONCLUSIONS

Research on the peer relations of children with DLD is in the early stages when it comes to taking a participatory approach, however there are some examples of inclusive practice from which the whole field can learn. The findings show that research that directly includes children with language disorders and takes account of their communication challenges can help build a more comprehensive knowledge of their world and leads to interesting avenues for interventions targeting social adjustment.Implications: Clinical implications are discussed with reference to the highlighted pragmatic language and social needs of children with DLD, which are typically not addressed unless disproportionately affected in comparison to structural language impairments.

Play and prosociality are associated with fewer externalizing problems in children with developmental language disorder: The role of early language and communication environment

BACKGROUND

Children with developmental language disorder (DLD) are at higher risk of poorer mental health compared with children without DLD. There are, however, considerable individual differences that need to be interpreted, including the identification of protective factors.

AIMS

Pathways from the early language and communication environment (ELCE, 1-2 years) to internalizing (peer and emotional problems) and externalizing (conduct problems and hyperactivity) problems in middle childhood (11 years) were mapped using structural equation modelling. Specifically, the role of indirect pathways via social skills (friendships, play and prosociality) in childhood (7-9 years) was investigated.

METHODS & PROCEDURES

Secondary analysis of existing data from the Avon Longitudinal Study of Parents and Children (ALSPAC) was undertaken. The study sample consisted of 6531 children (394 with DLD).

OUTCOMES & RESULTS

The pathways from the ELCE to internalizing and externalizing problems were similar for children with and without DLD. For both groups, a positive ELCE was associated with more competent social play and higher levels of prosociality in childhood, which in turn were associated with fewer externalizing problems in middle childhood. Furthermore, better friendships and higher levels of prosociality in childhood were both associated with fewer internalizing problems in middle childhood.

CONCLUSIONS & IMPLICATIONS

A child's ELCE is potentially important not only for the development of language but also for social development. Furthermore, in the absence of adequate language ability, play and prosocial behaviours may allow children with DLD to deploy, practise and learn key social skills, thus protecting against externalizing problems. We suggest that consideration be given to play- and prosociality-based educational and therapeutic services for children with DLD. What this paper adds What is already known on this subject On the whole, children with DLD tend to have poorer mental health compared with their unaffected peers. There are, however, considerable differences and poor outcomes are not inevitable. What this study adds to the existing knowledge We demonstrate that children's ECLE is important for the development of social play behaviours and prosociality. Whilst children with DLD tend to have less competent social play and lower levels of prosociality compared with their unaffected peers, those with more competent social play and higher levels of prosociality are likely to have fewer externalizing problems later in childhood. We speculate that in the absence of adequate structural language ability, play and prosocial behaviours allow children with DLD to deploy, practise and learn key relationship skills, alongside behavioural and emotional regulation skills, thus protecting against externalizing problems. What are the potential or actual clinical implications of this work? Understanding the relationships among play, prosociality and externalizing problems may pave the way for play- and prosociality-based interventions in children with DLD. This may be particularly appealing for practitioners as such interventions capitalize on one of the most intuitive means of learning in childhood: play with friends. The likelihood of acceptability and engagement with such interventions may be higher in children than for traditional adult-led, paper-and-pencil activities.

What Are the Peer Interaction Strengths and Difficulties in Children with Developmental Language Disorder? A Systematic Review

The current review gathers together research investigating peer interaction skills in children with Developmental Language Disorder (DLD) to give an overview of the strengths and challenges experienced by these children when interacting with other children. A systematic review was conducted to summarise the literature on peer interaction strengths and difficulties in children with DLD. No restrictions on time-period were made and the selection criteria accounted for many of the diagnostic labels previously used to refer to DLD. Studies included in this review involve English-speaking children of UK primary school age (4-11 years). A systematic search of databases identified 28 papers that met the inclusion criteria. Children with DLD are found to experience many challenges when interacting with peers. Difficulties have been found in studies exploring discourse characteristics such as turn-taking and in behaviours during play, such as access behaviours. Heterogeneity was however notable and peer interaction strengths are found in terms of the children's abilities to make friends, use verbal and non-verbal behaviour to make joint decisions with peers, and abilities to engage with peers in social pretend play. While it is encouraging to find research exploring many different areas of peer interaction competence in children with DLD, the research is highly disparate and there are many research findings awaiting replication. The current evidence base is unable to comprehensively define the characteristics of peer interactions of children with DLD.

Validity of the Play Assessment for Group Settings: an evaluation of differential item functioning between children with specific language impairment and typically developing peers

AIM

The purpose of this study was to evaluate the validity evidence based on internal structure of the Play Assessment for Group Settings (PAGS).

METHODS

The study was conducted in day care centres by comparing observations of the free play performance of two groups of children: those with specific language impairments (SLIs) (n=55) and those with typical language development (n=55). The participating children were 3 to 6.5 years of age. Data were subjected to many-faceted Rasch analyses and differential item functioning analysis was conducted to identify possible group-specific items in the PAGS. The effect of differentially functioning items on mean play performance measurements between two subgroups of children was controlled with two different independent samples t-tests.

RESULTS

According to the results, 80% of the test items were stable across the groups of children. Four items were harder for children with SLI, and clearly required language skills. Two items were relatively speaking easier for children with SLI, and reflected explorative functioning. The differential functioning items did not affect the ability of the PAGS to separate the children with SLI in mean play performance from their typically developing peers.

CONCLUSION

We concluded that the PAGS is a valid tool for identifying children who have challenges in their play performance and can be used for clinical purposes. However, the slight variability supports the fact that differential item functioning should be controlled in research when using the PAGS for comparison of different subgroups in play performance.