Social Functioning as a Mediator between Developmental Language Disorder (DLD) and Emotional Problems in Adolescents

Evaluating the association between developmental language disorder and depressive symptoms in preschool children

This study aims to investigate the association between developmental language disorder (DLD) and depressive symptoms in preschool-aged children, building upon previous research that has demonstrated emotional difficulties in children with DLD. Forty-one children with DLD or children at risk for DLD (DLD group) and 41 children with typical language development (TLD) were included in this study. Language development was evaluated using the TEDIL test which is a Turkish adaptation of the Test of Early Language Development-3. Auto acoustic Emissions Testing and Immittance-Metric Assessment were used to exclude children with hearing impairment. Developmental delays were excluded by Denver Developmental Screening Test II. Mothers filled out the Sociodemographic Data Form and the Child Depressive Symptoms Assessment Scale. The results demonstrate that children in DLD group scored significantly higher on the Child Depressive Symptoms Assessment Scale, manifesting increased levels of aggression, separation anxiety, impulsivity, hyperactivity, and encountering greater social adaptation difficulties and deterioration in cognitive processes than TLD. Multivariate regression analysis suggests that increased impulsivity and hyperactivity, alongside social and cognitive challenges, are predictors of DLD. The study concludes that depressive symptoms are more prevalent in children in DLD group than in their typically developing counterparts. These findings underscore the necessity for targeted psychiatric and pedagogical interventions, as well as individualized educational programs that cater to the socio-emotional and cognitive needs of children with DLD.

Exploring concepts of friendship formation in children with language disorder using a qualitative framework analysis

PURPOSE

Sociometric studies and adult reports have established that children with Language Disorder (LD) are at risk of peer relationship difficulties. However, we have limited knowledge of how children with LD understand friendship, whom they deem as a good or bad friend, and what role their friendship concepts play in their relationships with peers. This exploratory study aimed to conduct a qualitative investigation into the friendship concepts that children with LD hold and to explore their strategies for making friends.

METHODS

We conducted multiple, art-informed interviews on the topic of friendship with 14 children with LD at the age of 6-8 years. Participating children were based in the United Kingdom and Republic of Ireland. They attended enhanced provision, specific speech and language classes and mainstream classrooms. We used framework analysis to map children's responses to Selman's (1979) developmental model of interpersonal understanding, which espouses a theory of children's social development within the context of peer relationships.

RESULTS

The understanding of friendship formation in children with LD varied from physical presence to mutual support and sharing. Children's ideas about a good/bad friend represented the lowest developmental stage. Participants from the mainstream classroom demonstrated the highest stages of interpersonal understanding. Children with LD did not mention their language abilities as a barrier to making friends.

CONCLUSION

There are limited studies exploring friendship directly from children with LD, and this study provides insights into this gap, by utilising art-informed interviews. Children's immature understanding of a good/bad friend points towards a potential susceptibility to false friends, which we suggest needs further empirical validation. We also found that children with LD did not pay attention to their language difficulties when making friends, which raises questions about the ways diagnoses are shared with children.

WHAT THIS PAPER ADDS

What is already known on the subject Children with Language Disorder (LD) are at risk of peer relationship difficulties. Studies to date are based on sociometrics and adult reports. Only a few studies employ participatory approaches to research with children, directly engaging children with LD when exploring their friendships What this paper adds This paper directly asks children with LD about their understanding of friendship and strategies for making friends. Physical proximity and play are important to children.s understanding of friendship especially in recognising good and bad friends. This indicates potential reasons for children with LD being susceptible to false friends Additionally, children with LD do not perceive language and communication as a barrier to making friends. What are the potential or actual clinical implications of this work? Concepts around friendship and good/bad friends should be routinely assessed and targeted (if appropriate) in interventions. The study highlights the need to continue discussing practices around sharing diagnoses with children with LD.

Enhancing social-emotional functioning in adolescents with developmental language disorder or deaf or hard of hearing through a Theory of Mind intervention

BACKGROUND

This study examines the effect of a Theory of Mind (ToM) intervention on ToM abilities and social-emotional functioning in adolescents with developmental language disorder (DLD) or who are deaf/hard of hearing (D/HH). It emphasizes the importance of self-reflection and measurement for personal growth. The research design incorporates both subjective and objective measures to evaluate the intervention's efficacy.

AIMS

To investigate the impact of the ToM intervention on ToM abilities and social-emotional functioning in adolescents with DLD or who are D/HH. It hypothesizes that participants in the intervention groups will show improved ToM and social-emotional functioning compared with those in the control groups.

METHODS & PROCEDURES

Adolescents with DLD or who are D/HH were recruited through collaboration with educational institutions. The study utilized a pre-/post-test design, assigning participants to either the intervention or the control group. The ToM intervention involved targeted activities to enhance ToM abilities. ToM abilities and social-emotional functioning were assessed using standardized tests and self-report questionnaires. Statistical analyses compared outcomes between the intervention and no intervention groups.

OUTCOMES & RESULTS

The findings reveal subjective improvements in social-emotional functioning among the D/HH intervention group. However, no significant effects on objective ToM measures were observed. These results highlight the need for further investigation and refinement of interventions in these areas. Future research should focus on improving intervention strategies and exploring additional objective measures to gain a comprehensive understanding of the intervention's impact on ToM and social-emotional functioning in this population.

CONCLUSIONS & IMPLICATIONS

The ToM intervention shows subjective benefits in improving social-emotional functioning among D/HH adolescents. However, it does not yield significant effects on objective ToM measures. These findings emphasize the ongoing need to refine interventions targeting ToM abilities and social-emotional functioning in this population. Future studies should explore alternative strategies and incorporate additional objective measures to enhance understanding and outcomes.

WHAT THIS PAPER ADDS

What is already known on this subject Before this study, it was known that ToM interventions have the potential to enhance ToM abilities. However, the specific effects of such interventions on subjective and objective measures for ToM and social-emotional functioning in adolescents with DLD or who are D/HH remained unclear, necessitating further research. What this paper adds to the existing knowledge This study adds to the existing knowledge by demonstrating subjective improvements in social-emotional functioning among adolescents who are D/HH and underwent a ToM intervention. However, no significant effects on objective ToM measures were observed. These findings highlight the need for refining interventions and exploring additional measures to better understand the intervention's impact. What are the potential or actual clinical implications of this work? The subjective improvements in social-emotional functioning observed in this study have important clinical implications. They suggest that ToM interventions can positively impact the social well-being of adolescents who are D/HH. However, the lack of significant effects on objective ToM measures emphasizes the need for further research and intervention refinement to address specific areas of improvement in this population.

The informant matters: Differences in bullying victim categorization rates assessed with self- and peer-reports in children with developmental language disorder and reading difficulties

BACKGROUND

Children with Developmental Language Disorder (DLD) and Reading Difficulties (RD) can show more peer relation problems depending on the informant.

AIMS

(1) To explore bullying victims' categorization, evaluated by self- and peer-reports, in children with DLD and RD; and (2) to assess agreement rates between informants.

METHOD AND PROCEDURES

Victimization was assessed using a self-report (EBIP-Q) and a peer-report sociogram (CESC) in a sample of 83 participants (9-12 years; 10.5 ± 1.1 years), comprising of DLD (n = 19), RD (n = 32), and Control (n = 32) groups.

OUTCOMES AND RESULTS

We found a higher frequency of the rejected sociometric profile in the DLD and RD groups, a higher peer-reported victimization in the DLD group, and more severe self-reported victimization in the DLD and RD groups. Odds of being classified as victimized were higher for self-report except in the DLD group. Informants' agreement was high using the most restrictive EBIP-Q criterion (7 points) for both the Control and the RD groups, being non-significant for the DLD group regardless of the criteria used.

CONCLUSIONS AND IMPLICATIONS

We found a higher victimization risk in children with language difficulties, although self-assessment seems to under-detect children with DLD according to the agreement rates, pointing out the need to combine assessments and informants. WHAT DOES THIS PAPER ADD?: Several studies have shown that children with DLD or RD obtain higher scores of victimization and score lower on several scales of social skills with continuous data. Although continuous analyses are usual in research, professional decisions are usually based on cut-off criteria more than how high or low a score is in contrast to another group. This is one of the first works that analyses victimization following the cut-off criteria of self and peer assessments that professionals used in the school settings in children with DLD and RD. Our results will raise awareness among school professionals based on the evidence about the high risk of victimization, especially in children with DLD, and the implications of selecting between several measures of victimization, in this group of children. We think that our results would help to better detect and prevent bullying in schools for children with DLD.

Linking Language Skills and Social Competence in Children With Developmental Language Disorder: A Systematic Review and Meta-Analysis

PURPOSE

This systematic review and meta-analysis aimed to examine the association between language skills and social competence in children with developmental language disorder (DLD) and to assess the potential moderators of these associations.

METHOD

The study was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were identified according to a search strategy carried out in PsycINFO, MEDLINE, Scopus, Linguistics and Language Behavior Abstracts, and ProQuest Dissertations and Theses Global databases. A total of 15,069 articles were independently double screened in the title and abstract phases, with 250 articles proceeding to a full-text review. Inclusion criteria comprised (a) a sample of children with DLD between the ages of 2 and 12 years, (b) a language measure, (c) a social competence measure, and (d) an appropriate statistic. Exclusion criteria were (a) intervention studies with no baseline data, (b) language measures based on preverbal abilities, (c) samples of children with DLD and other clinical conditions, and (d) studies without useable statistics. Data were extracted from 21 studies that met the eligibility criteria for the meta-analysis.

RESULTS

Pooled estimates across 21 studies (Mage = 7.52 years; 64% male) and 6,830 children indicated a significant association between language skills and social competence in children with DLD (r = .18, 95% confidence interval [.12, .24], p < .001), which was small in magnitude. The effect sizes were stronger in studies that assessed overall language skills than in those that specifically measured receptive or expressive language skills.

CONCLUSIONS

Findings from this study support a subtle and reliable relationship between language and social competence in children with DLD. The implications and limitations of this study and its future directions are also discussed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24514564.

How do children with language disorder perceive their peer interactions? A qualitative investigation

Background and aims

Peer interaction difficulties are often elevated amongst children with language disorders, yet the mechanisms underlying these difficulties are unclear. Previous research indicates that poor conflict management, social withdrawal, emotion regulation difficulties, and reduced prosocial behavior may contribute to peer interaction difficulties. However, this research often uses adult perspectives, failing to acknowledge child perceptions of these experiences. The present study aimed to qualitatively investigate perceptions of peer interactions from the perspective of children with language disorders.

Methods

Seven participants aged between 7- and 10-years-old took part. All participants were diagnosed with a language disorder and had language as their primary area of difficulty. Participants were recruited from a specialist language school and via an online database. Semi-structured interviews were conducted, with participants given the choice to answer questions verbally or creatively, using toys or drawing materials. Interview transcripts were analyzed using interpretative phenomenological analysis.

Results

Participants valued play, conversation, and helping others. They felt that spending time with peers could alleviate loneliness. However, sometimes solitude was needed as social interaction could be overwhelming. Participants found conflict challenging and exhibited difficulties with regulating emotions. Participants relied on running away, retaliation, or asking an adult for help, to resolve conflict.

Conclusions and implications

The findings suggest that children with language disorders are socially motivated and have relative strengths in displaying prosocial behavior. However, children with language disorders require support to promote positive relationships. This support includes help with making deeper connections with peers, opportunities to spend time alone when needed, and providing adept conflict resolution and emotion regulation strategies.

How word meaning structure relates to executive functioning and theory of mind in children with developmental language disorder: A multiple case study

Background and aims

Many children with developmental language disorder (DLD) have difficulties in executive functioning (EF) and theory of mind (ToM). These difficulties might be explained by the theory that children's conceptual understanding changes over five stages of word meaning structure, from concrete and context-dependent to abstract and precise. We present a multiple case study examining how word meaning structure relates to EF and ToM in children with DLD.

Methods

Participants were five children with DLD aged 9-12 and five typically developing children matched for age, gender, and nonverbal intelligence. Word meaning structure was assessed using new dynamic test. EF was assessed using the Zoo Map Task and Behavioral Rating Inventory for EF. ToM was assessed using the ToM test, Frith-Happé Animations, and Bermond-Vorst Alexithymia Questionnaire. Behavioral problems were measured using the Child Behavior Checklist. Anamnestic interviews with the parents were conducted to describe the case histories.

Results

For the children with DLD, lower scores in the word meaning structure task were observed compared to those observed for their matched peers, with no statistical test applied. Word meaning structure related positively to EF and ToM, but not to behavioral problems. Instances in which word meaning structure dissociates from EF and ToM are discussed in individual case descriptions.

Conclusions

By linking language to conceptual development, variations in word meaning structure may explain some EF and ToM difficulties in children with DLD.

Implications

The present study offers a basis for future research on the relationships among word meaning structure, EF, and ToM.

The role of language in mental health during the transition from primary to secondary education

We report a preregistered analysis to test whether children meeting diagnostic criteria for language disorder (LD) have higher self-reported and/or parent-reported mental health symptoms during the transition from primary to secondary education. Data are from a UK-based longitudinal cohort study, The Surrey Communication and Language in Education Study (SCALES). SCALES oversampled children at risk of LD at school entry. Language was measured using a battery of standardised assessments in Year 1 (age 5-6 years, n = 529), and mental health symptoms were measured using self and parent report in Year 6 (age 10-11 years, n = 384) and Year 8 (age 12-13 years, n = 246). Social experiences were also measured using self-report measures in Year 6. Mental health symptoms were stable during the transition from primary to secondary school. Symptom rates did not differ between children with and without LD based on self-report, but children with LD had higher parent-reported mental health symptoms than their peers with typical language. Similarly, early language was negatively associated with parent-reported but not self-reported mental health symptoms. Early language was associated with fewer child-reported positive social experiences in Year 6, but social experiences did not mediate the association between language and mental health. We found poor agreement between parent and self-reported child mental health symptoms across language groups. Future studies should aim to determine sources of disagreement between parent and child report, particularly for children with communication difficulties who may struggle to accurately self-report mental health symptoms.

Camouflaging in Developmental Language Disorder: The Views of Speech and Language Pathologists and Parents

The term camouflaging describes behaviors that cover up neurodivergent difficulties. While researched in autism, camouflaging has received no systematic study in other conditions affecting communication, including developmental language disorder (DLD). This study explored camouflaging in DLD, drawing on the experience and expertise of speech and language pathologists and parents of children with DLD. Using a qualitative descriptive design, we interviewed six speech and language pathologists and six parents of children with DLD. The inductive thematic analysis considered three broad topic areas: What camouflaging behaviors do children with DLD do, the impacts of camouflaging, and what factors are associated with camouflaging. Camouflaging took a range of forms, with eight common presentations identified. Camouflaging reportedly delayed recognition of children's language needs and affected interventions. Camouflaging reportedly impacted children's exhaustion, mental health, self-esteem, personality, friendships, and how others view them. Research characterizing camouflaging in DLD could help reduce the underdetection of children's language needs.

Do speech-language therapists support young people with communication disability to use social media? A mixed methods study of professional practices

BACKGROUND

Social media is increasingly used by young people, including those with communication disability. To date, though, little is known about how speech-language therapists (SLTs) support the social media use of young people with communication disability.

AIMS

To explore what services SLTs provide to facilitate the social media use of young people with communication disability, including what these services look like, and the factors that impact SLTs' professional practices.

METHODS & PROCEDURES

A sequential mixed methods approach was employed including an online survey and in-depth semi-structured interviews. Participants were qualified practising SLTs in Australia with a caseload that included clients aged 12-16 years. Quantitative data were analysed with SPSS. A thematic analysis of qualitative data was conducted with NVivo.

OUTCOMES & RESULTS

Survey responses from 61 SLTs were analysed. Interviews were conducted with 16 participants. Survey data indicated that SLTs do not systematically assess or treat young people's use of social media as part of their professional practice. Interview data revealed that where SLTs do support young people's use of social media, they transfer knowledge and practices typically used in offline contexts to underpin their work supporting clients' use of social media. In terms of factors that affect SLTs' practices, three major themes were identified: client/family factors, SLT factors, and societal factors.

CONCLUSIONS & IMPLICATIONS

While young people with communication disability may desire digital participation in social media spaces, SLTs' current professional practices do not routinely address this need. Professional practice guidelines would support SLTs' practices in this area. Future research should seek the opinions of young people with communication disability regarding their use of social media, and the role of SLTs in facilitating this.

WHAT THIS PAPER ADDS

What is already known on the subject Young people with communication disability use social media, but digital inequality means that they may not do so to the same extent as their typically developing peers. Services targeting a young person's social media use is within the SLT scope of practice. Whether or not SLTs routinely address the social media use of young people with communication disability as part of their professional practice is unknown. What this study adds to existing knowledge This study found that SLTs in Australia do not systematically provide professional services targeting young people's use of social media. When services do address a young person's use of social media, knowledge and practices typically used by SLTs in offline contexts are adapted to support their work targeting online social media contexts. What are the potential or actual clinical implications of this work? This study indicates that SLTs should consider a range of factors when deciding whether to address a young person's social media use. Adapting existing offline professional practices to online environments could support SLTs' work in providing services targeting social media use. Professional practice guidelines would support SLTs' work facilitating the social media use of young people with communication disability.

Preliminary data on the development of emotion vocabulary in typically developing children (5-13 years) using an experimental psycholinguistic measure

Introduction

Vocabulary of emotion is integral to emotional development and emotional intelligence is associated with improved mental health outcomes. Many language disordered groups experience emotional difficulties; Developmental Language Disorders, Attention Deficit Hyperactivity Disorder and autism. However, (as in the case of autism) research tends to focus on assessing recognition of emotional states, rather than exploring labeling skills. Where labeling is assessed, measures have focused on early-acquired vocabulary (happy, sad, angry) or self/parent reporting. To date, no objective assessment has been made of vocabulary of emotion across childhood.

Methods

This study uses an experimental psycholinguistic measure, The Emotion Vocabulary: Expressive and Receptive ability measure (EVER) which includes two tasks (receptive vocabulary and word generation/expressive vocabulary). This measure has capacity to demonstrate vocabulary growth across age groups. 171 participants (5.0-13.11 years) completed The EVER Measure, alongside two closely matched standardized measures of basic language: BPVS (receptive vocabulary task) and CELF (word-association task). Assessments were completed online and en vivo (COVID testing restrictions dependent).

Results

As predicted, children's accuracy increased on both receptive and expressive emotion vocabulary tasks, in line with age at time of testing. EVER scores were significantly predicted by age and correlated with matched basic language scores. Secondary analysis provided preliminary findings on age of acquisition for specific emotion vocabulary items.

Discussion

The findings consequently demonstrate proof of concept for the use of The EVER Measure in assessing emotional vocabulary across childhood. This study provides important preliminary data on generating and recognizing emotion labels across typical child development. Critically, it extends current knowledge on emotion vocabulary acquisition into middle childhood, where linguistic ability is relatively mature. As such, findings have implications for research with potential clinical application in the assessment of older children, with either language or emotional differences or both. Findings demonstrate the need for a standardized tool, and its potential application in research and clinical practice is explored. A large-scale study offering proof of concept and reliability of The EVER Measure is indicated.

Vocabulary Abilities and Parents' Emotional Regulation Predict Emotional Regulation in School-Age Children but Not Adolescents With and Without Developmental Language Disorder

A comprehensive approach, including social and emotional affectations, has been recently proposed as an important framework to understand Developmental Language Disorder (DLD). There is an increasing considerable interest in knowing how language and emotion are related, and as far as we know, the role of the emotional regulation (ER) of parents of children with and without DLD, and their impact on their children's ER is still unknown. The main aims of this study are to advance our knowledge of ER in school-age children and adolescents with and without DLD, to analyze the predictive value of expressive and receptive vocabulary on ER in school-age children and adolescents, and to explore parental ER and their effect on their children's and adolescents' ER. To cover all objectives, we carried out three studies. In the first and second study, expressive and receptive vocabulary were assessed in wave 1, and ER (Emotional Regulation Checklist -ERC- for children and Emotion Regulation Scale -DERS- for adolescents) was assessed in wave 2, 4 years later. Participants in the first study consisted of two groups of school-aged children (13 had DLD and 20 were typically developing children -TD). Participants in the second study consisted of two groups of adolescents (16 had DLD and 16 were TD adolescents). In the third study, the ER of 65 of the parents of the children and adolescents from study 1 were assessed during wave 2 via self-reporting the DERS questionnaire. Results showed no significant differences in ER between DLD and TD groups neither in middle childhood nor in adolescence. Concerning vocabulary and ER, expressive language predicted ER in school-age children but not in adolescents. Finally, parental ER explained their school-age children's ER, but this was not the case in adolescents. In conclusion, the present data indicated that expressive vocabulary has a fundamental role in ER, at least during primary school years, and adds new evidence of the impact of parents' ER upon their children's ER, encouraging educators and speech language pathologists to include parents' assessments in holistic evaluations and interventions for children with language and ER difficulties.

Associations Between Self, Peer, and Teacher Reports of Victimization and Social Skills in School in Children With Language Disorders

Previous studies have shown that teachers and parents of children with language disorders report them to have higher victimization scores, a heightened risk of low-quality friendships and social difficulties, and may be more vulnerable to peer rejection than control peers. However, there are few studies of bullying in children with developmental language disorder (DLD) and reading difficulties (RD), and none has considered the mutual relationships between teacher reports, the perceptions of classmates, and children's self-reports. We analyzed the experiences of bullying and peer relationships in primary school students with DLD and RD as compared to their age-matched peers using teacher reports, peer reports, and self-reports on victimization. Additionally, we explored how these three perspectives are associated. Results indicated lower levels of peer-rated prosocial skills in DLD and RD students compared to their peers, as well as higher levels of victimization as assessed by peers for students with DLD. In the same line, the teachers' ratings showed that students with DLD presented poorer social skills, less adaptability, and more withdrawal in social interaction. Contrastingly, self-reports informed of similar rates of interpersonal relationships, social stress, and peer victimization between the three groups. Consequently, we found significant correlations between measures of peer reports and teacher reports that contrasted with the lack of correlations between self and other agents' reports. These findings stress the importance of using self-reports, peer reports, and teacher reports at the same time to detect bullying situations that might go unnoticed.

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.