BackgroundDiagnosis of ‘specific’ language impairment traditionally required nonverbal IQ to be within normal limits, often resulting in restricted access to clinical services for children with lower NVIQ. Changes to DSM‐5 criteria for language disorder removed this NVIQ requirement. This study sought to delineate the impact of varying NVIQ criteria on prevalence, clinical presentation and functional impact of language disorder in the first UK population study of language impairment at school entry.MethodsA population‐based survey design with sample weighting procedures was used to estimate population prevalence. We surveyed state‐maintained reception classrooms (n = 161 or 61% of eligible schools) in Surrey, England. From a total population of 12,398 children (ages 4–5 years), 7,267 (59%) were screened. A stratified subsample (n = 529) received comprehensive assessment of language, NVIQ, social, emotional and behavioural problems, and academic attainment.ResultsThe total population prevalence estimate of language disorder was 9.92% (95% CI 7.38, 13.20). The prevalence of language disorder of unknown origin was estimated to be 7.58% (95% CI 5.33, 10.66), while the prevalence of language impairment associated with intellectual disability and/or existing medical diagnosis was 2.34% (95% CI 1.40, 3.91). Children with language disorder displayed elevated symptoms of social, emotional and behavioural problems relative to peers, F(1, 466) = 7.88, p = .05, and 88% did not make expected academic progress. There were no differences between those with average and low‐average NVIQ scores in severity of language deficit, social, emotional and behavioural problems, or educational attainment. In contrast, children with language impairments associated with known medical diagnosis and/or intellectual disability displayed more severe deficits on multiple measures.ConclusionsAt school entry, approximately two children in every class of 30 pupils will experience language disorder severe enough to hinder academic progress. Access to specialist clinical services should not depend on NVIQ.

Narrative is a good way of assessing linguistic ability in older children with communication impairments. Core language abilities rather than pragmatic skill or diagnostic status are likely to influence narrative development.

Background: Two studies were conducted to test claims that pragmatic language impairment (PLI – previously referred to as semantic‐pragmatic disorder) is simply another term for autistic disorder or pervasive developmental disorder not otherwise specified (PDDNOS). Method: In Study 1, 21 children aged from 6 to 9 years with language impairments were subdivided on the basis of the Children's Communication Checklist into 13 cases of pragmatic language impairment (PLI) and eight cases of typical specific language impairment (SLI‐T). Parents completed the Autism Diagnostic Interview – Revised (ADI‐R) and the Social Communication Questionnaire (SCQ), and the children were given the Autism Diagnostic Observation Schedule – Generic (ADOS‐G). In Study 2, a further 11 children with SLI‐T and 18 with PLI were assessed using the SCQ and ADOS‐G. In addition, six children diagnosed with high‐functioning autism and 18 normally developing children were assessed. Results: There was good agreement between ADI‐R and SCQ diagnoses, but poor agreement between diagnoses based on these parental report measures and those based on ADOS‐G. In many children, symptom profiles changed with age. Four PLI children from Study 1 and one from Study 2 met criteria for autistic disorder on both parental report (ADI‐R or SCQ) and ADOS‐G. Many of the others showed some autistic features, but there was a subset of children with pragmatic difficulties who were not diagnosed as having autism or PDDNOS by either instrument. These children tended to use stereotyped language with abnormal intonation/prosody, but they appeared sociable and communicative, had normal nonverbal communication, and showed few abnormalities outside the language/social communication domains. Conclusions: Presence of pragmatic difficulties in a child with communication problems should prompt the clinician to evaluate autistic symptomatology, but it is dangerous to assume that all children with pragmatic difficulties have autism or PDDNOS.

Happé (1993) proposed that theory of mind (ToM) understanding was necessary for comprehension of metaphorical expressions. The current study investigated the role of both ToM and language ability in metaphor understanding. Ninety-four children aged 8-15 years with communication impairments were grouped according to language ability and autistic symptomatology in the first instance, and then according to ToM performance. Their performance on a metaphor task was compared to 34 typically developing age-matched peers. These analyses showed that only children with language impairment, with or without concurrent autistic features, were impaired on the metaphor task. Furthermore, possession of first-order ToM skills did not ensure metaphor comprehension. Instead, semantic ability was a stronger predictor of performance on the metaphor task. These results are considered with reference to the view that ToM understanding is necessary for the comprehension of metaphor.

CCC-2 provides a useful screening measure for communication impairment and can be helpful in identifying children who should be referred for more detailed assessment of possible autistic spectrum disorder. However, the present data highlight substantial overlap amongst groups with 'distinct' diagnoses. It is suggested that it is unrealistic to use the CCC-2 to make categorical distinctions on this continuum of disorder.

An investigation is reported into the story comprehension abilities of four groups of children: those with typical specific language impairment (SLI-T), those with pragmatic language impairments who were not autistic (PLI), those with high-functioning autism (HFA) and typically developing controls. The story comprehension task required children to answer questions about the literal content of the story, as well as questions involving two types of inferences: text-connecting and gap-filling. The control children outscored the three clinical groups on story comprehension, but the group means of the clinical groups did not differ. However, categorical examination of the data revealed that children with pragmatic difficulties related to HFA were more likely to have specific inferencing deficits. Error analysis suggested that all children could make inferences, but these were not always relevant to the story context. This supports the notion of weak central coherence underlying deficits in inferencing. There were no group differences on story recall. However, there was a strong relationship between story comprehension and recall, in that those who had better comprehension tended to have better recall. It is concluded that comprehension aids recall by enabling the listener to build a more stable mental representation of the story. The pragmatic deficits seen in autism compromise this process.

Phonological skills, language ability, and literacy scores were compared for four groups: 19 children with mild-to-moderate sensorineural hearing loss (SNH), 20 children with specific language impairment (SLI), 20 controls matched on chronological age to the SNH group (CA), and 15 controls matched on receptive vocabulary level to a subset of the SLI group (CB). In common with the SLI group, mean scores of children with mild-to-moderate hearing loss were significantly poorer on tests of phonological short-term memory, phonological discrimination, and phonological awareness than CA controls. No differences between group means were observed in SNH and CA control groups on vocabulary, digit and sentence recall, sentence comprehension, and literacy scores. However, there was considerable individual variation within the SNH group. Nearly 50% of the SNH group showed phonological impairment associated with poorer expressive and receptive vocabulary and higher hearing thresholds than remaining children without phonological impairment. Nonword repetition deficits were observed in SNH subgroups with and without phonological impairment and were of a similar magnitude to those observed in children with SLI. Indeed, poorer repetition in children with SLI could only be differentiated from children with SNH on phonologically complex nonwords. Overall, findings suggested major problems in nonword repetition and phonological impairment occurred without clinically significant deficits in wider language and literacy abilities in children with mild-to-moderate sensorineural hearing loss. Implications for theories of SLI are discussed.

Children with language impairments have limitations of phonological short-term memory (STM) and have distinctive problems with certain aspects of grammar. Both deficits have been proposed as phenotypic markers of heritable language impairment. We studied 173 twin pairs, selected to be over-representative of children with risk of developmental language impairment, using a battery of standardized language and intelligence tests, a test of nonword repetition to index phonological STM and two elicitation tasks to assess use of verb tense marking. As predicted, the phonological STM and the verb tense measures both discriminated children with risk of language impairment from low risk children, and DeFries-Fulker analysis showed that impairments on both tasks were significantly heritable. However, there was minimal phenotypic and etiological overlap between the two deficits, suggesting that different genes are implicated in causing these two kinds of language difficulty. From an evolutionary perspective, these data are consistent with the view that language is a complex function that depends on multiple underlying skills with distinct genetic origins.