Editorial: The search for core symptoms - will this help clinical decision-making?

Diagnosis is an important component of our clinical roles, and should also lead to particular treatment pathways. The diagnostic process may be challenged by co‐occurring deficits that are neither specific nor universal to the diagnosis under consideration and may well be evident across a range of other clinical conditions. How important is it to refine our instruments so that they measure unique symptoms? Will this alter or improve intervention choices? This Editorial focuses on the extent to which fine tuning diagnostic instruments improves our decisions about treatment, in the context of articles published in this issue of JCPP

One size does not fit all: addressing the challenges of intervention for complex developmental issues

The Journal of Child Psychology and Psychiatry is committed to publishing implementational research, or turning therapeutic research discoveries into practical benefit for human health and well‐being. This editorial showcases three such papers in this issue from diverse fields in developmental science. The papers highlight the challenges of implementing intervention under real‐world constraints, and highlight key issues that clinicians and researchers will need to address in future work. Despite these challenges, each approach shows promise and innovation in delivering high‐quality interventions to vulnerable children and families

Social (pragmatic) communication disorders and autism spectrum disorder

Changes have been made to the diagnostic criteria for autism spectrum disorder (ASD) in the recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and similar changes are likely in the WHO International Classification of Diseases (ICD-11) due in 2017. In light of these changes, a new clinical disorder, social (pragmatic) communication disorder (SPCD), was added to the neurodevelopmental disorders section of DSM-5. This article describes the key features of ASD, SPCD and the draft ICD-11 approach to pragmatic language impairment, highlighting points of overlap between the disorders and criteria for differential diagnosis

Evaluation of an interview skills training package for adolescents with speech, language and communication needs

BACKGROUND & AIMS: We evaluated a structured intervention programme aimed at preparing adolescents with developmental language disorders for job interviews. Our primary outcome measures included change in ratings of verbal and non‐verbal social communication behaviours evident during mock interviews. METHODS & PROCEDURES: In study 1, 12 participants, aged 17–19 years, from a specialist sixth‐form college completed the intervention and two mock interviews, one pre‐ and one post‐intervention. In study 2, 34 participants, aged 17–19 years, completed a modified intervention programme and three mock interviews, one at baseline (included to control for possible practise effects), one pre‐ and one post‐intervention. In both studies, interviews were video recorded and social communication behaviours were coded by independent assessors blind to interview time, participant diagnosis and therapy content. A repeated‐measures design was employed to measure change in communication behaviours. OUTCOMES & RESULTS: In study 1, a significant increase in the number of ‘positive’ verbal and non‐verbal social communication behaviours was observed from pre‐ to post‐intervention. However, there was no significant change in the number of ‘negative’ behaviours (i.e., fidgeting, irrelevant remarks). In study 2, there were no significant changes in verbal behaviours, but significant group differences (though wide individual variation) in both positive and negative non‐verbal social communication behaviours. CONCLUSIONS & IMPLICATIONS: Our findings suggest that training specific social communication skills that are important for interview success, and consistently reinforcing those behaviours during therapy practice, can increase the use of those skills in an interview setting, though in this heterogeneous population there was considerable variation in therapy outcome. The skills of the interviewer were identified as a potential source of variation in outcome, and a target for future research and practice

Sources of variability in the prospective relation of language to social, emotional, and behavior problem symptoms: Implications for developmental language disorder

Children with developmental language disorder (DLD) are at risk for social, emotional, and behavioral (SEB) maladjustment throughout development, though it is unclear if poor language proficiency per se can account for this risk as associations between language and SEB appear more variable among typical-language children. This study investigated whether the relationship between language and SEB problems is stronger at very low levels of language and considered confounders including socioeconomic status, sex, and nonverbal intelligence. These were examined using a population-based survey design, including children with a wide range of language and cognitive profiles, and assessed using the Strengths and Difficulties Questionnaire and six standardized language measures (n = 363, weighted n = 6,451). Structural equation models adjusted for prior levels of SEB revealed that the relationship of language at age 5–6 years to SEB at 7–9 years was nonlinear. Language more strongly predicted all clusters of SEB at disordered language levels relative to typical language levels, with standardized betas of −.25 versus .03 for behavioral, −.31 versus −.04 for peer, and .27 versus .03 for prosocial problems. Wald tests between these pairs of betas yielded p values from .049 to .014. Sex moderated the nonlinear association between language and emotional symptoms. These findings indicate a clinical need to support language development in order to mitigate against problems of SEB and to carefully monitor the mental health needs of children with DLD, particularly in the context of multiple, and potentially sex-specific, risks

Parents modify gesture according to task demands and child language needs

Parent–child interaction plays a crucial role in early language acquisition. In young typically developing children, direct and indirect relationships between parent gesture, child gesture and child language have been observed. Far less is known about these relationships in atypical language development. The present study investigated parent gesture frequency in relation to child gesture frequency and language ability. Parent–child dyads were observed for children aged 6–8 years with developmental language disorder (DLD: n = 21) relative to parents of typically developing peers (TD: n = 18) and children with low language (LL) and educational concerns (n = 21). Parents of children with DLD gestured at significantly higher rates than parents of TD children, but only during a complex interactive problem solving task. Across the entire sample, parent gesture rate was positively correlated with child gesture rate, but negatively correlated with child vocabulary. Parent gesture thus may serve as a strategy to maximise communication success for children with language difficulties and is most evident when communication demands are high

Editorial: New frontiers in the scientific study of developmental language disorders

Developmental language disorders (DLD) are common and have far‐reaching developmental consequences. Nevertheless, public awareness of DLD is poor, and one goal of this special issue is to showcase a set of papers that provide a clear and coherent message about the nature and impact of DLD, and the potential of intervention to mitigate these impacts. In this editorial, we highlight seminal papers JCPP has published on language disorders over the last 40 years. Many of the issues raised then are still relevant now; however, the papers that comprise this special issue exemplify how far the field has come in achieving consensus on terminology and diagnostic criteria, and producing highly consistent findings on the stability and impact of DLD, and the potential for language change in response to targeted interventions. The editorial concludes with a road map for future research and clinical priorities that includes the need for randomised controlled trials that specifically address the impact of co‐morbidities on response to treatment, impacts of intervention on broader developmental outcomes, and the experiences of adults with DLD

Does impaired grammatical comprehension provide evidence for an innate grammar module?

Children with specific language impairment (SLI) have distinctive impairments in the comprehension of sentences that involve long-distance syntactic relationships. This has been interpreted as evidence for impairment in an innate grammatical module. An alternative theory attributes such difficulties to lower level problems with speech perception or deficits in phonological working memory. These theoretical accounts were contrasted using comprehension data from three sub-groups: 20 children with SLI, 19 children with mild-moderate hearing loss, and normally developing children matched on age and/or language level. There were close similarities between the hearing-impaired and SLI groups on a measure of phoneme perception. Children with SLI did poorly on tests assessing knowledge of Binding principles and in assigning thematic roles in passive sentences whereas hearing-impaired children performed close to control levels, indicating that poor speech perception cannot account for this pattern of deficit. However, the pattern of errors on syntactic tasks and the relatively weak correlation between different indicators of syntactic deficit seemed incompatible with a modular hypothesis. We propose that limited processing capacity is the principal determinant of deficient syntactic comprehension in SLI

Sleep Promotes Phonological Learning in Children Across Language and Autism Spectra

Purpose: Establishing stable and flexible phonological representations is a key component of language development and one which is thought to vary across children with neurodevelopmental disorders affecting language acquisition. Sleep is understood to support the learning and generalization of new phonological mappings in adults, but this remains to be examined in children. This study therefore explored the time course of phonological learning in childhood and how it varies by structural language and autism symptomatology. / Method: Seventy-seven 7- to 13-year-old children, 30 with high autism symptomatology, were included in the study; structural language ability varied across the sample. Children learned new phonological mappings based on synthesized speech tokens in the morning; performance was then charted via repetition (without feedback) over 24 hr and followed up 4 weeks later. On the night following learning, children's sleep was monitored with polysomnography. / Results: A period of sleep but not wake was associated with improvement on the phonological learning task in childhood. Sleep was associated with improved performance for both trained items and novel items. Structural language ability predicted overall task performance, though language ability did not predict degree of change from one session to the next. By contrast, autism symptomatology did not explain task performance. With respect to sleep architecture, rapid eye movement features were associated with greater phonological generalization. / Conclusions: Children's sleep was associated with improvement in performance on both trained and novel items. Phonological generalization was associated with brain activity during rapid eye movement sleep. This study furthers our understanding of individual differences in the acquisition of new phonological mappings and the role of sleep in this process over childhood. / Supplemental Material: https://doi.org/10.23641/asha.11126732

Does a child’s language ability affect the correspondence between parent and teacher ratings of ADHD symptoms?

Background: Rating scales are often used to identify children with potential Attention-Deficit/Hyperactivity Disorder (ADHD), yet there are frequently discrepancies between informants which may be moderated by child characteristics. The current study asked whether correspondence between parent and teacher ratings on the Strengths and Weakness of ADHD symptoms and Normal behaviour scale (SWAN) varied systematically with child language ability. Method: Parent and teacher SWAN questionnaires were returned for 200 children (aged 61–81 months); 106 had low language ability (LL) and 94 had typically developing language (TL). After exploring informant correspondence (using Pearson correlation) and the discrepancy between raters, we report inter-class correlation coefficients, to assess inter-rater reliability, and Cohen’s kappa, to assess agreement regarding possible ADHD caseness. Results: Correlations between informant ratings on the SWAN were moderate. Children with LL were rated as having increased inattention and hyperactivity relative to children with TL; teachers, however, rated children with LL as having more inattention than parents. Inter-rater reliability of the SWAN was good and there were no systematic differences between the LL and TL groups. Case agreement between parent and teachers was fair; this varied by language group with poorer case agreement for children with LL. Conclusion: Children’s language abilities affect the discrepancy between informant ratings of ADHD symptomatology and the agreement between parents and teachers regarding potential ADHD caseness. The assessment of children’s core language ability would be a beneficial addition to the ADHD diagnostic process.</p