Specific Language Impairment

My parents recently heard J. Bruce Tomblin give a talk. He is a professor emeritus at the University of Iowa, in the Department of Communication Sciences and Disorders. He was discussing specific language impairment.

I’ve previously suspected that my own language difficulties might be related to autism spectrum disorders [ASD], but specific language impairment [SLI] might be better fit. As for symptoms, there is some overlap between ASD and SLI. A big difference is that SLI has no specific direct causes as to be found in IQ differences, brain damage, etc. SLI kids otherwise appear normal, although as with ASD there can be difficulties with socializing. Language is kind of important for developing and maintaining relationships.

This is the first time I’ve heard of SLI and, despite being far more common (5-8% of kids) than ASD or dyslexia (less than 1% in both cases), it is less well known. An interesting explanation for this is that parents of SLI children also tend to have language difficulties which impacts interpersonal skills and so they there are fewer people to effectively advocate for SLI. The sad consequence is relatively little money has gone into funding SLI research and so SLI kids rarely get the help they need. It’s a non-flashy condition and so easily ignored. No one makes movies, tv shows, and documentaries about those struggling with SLI.

By the way, the UI Department of Communication Sciences and Disorders had its origins in stuttering. One of the founders was Dean Williams. I had some stuttering as a child, as did my brother, although for different reasons. Mine was related to language and my brother’s to anxiety. I bring this up because my brother worked directly with Dean Williams when he was younger, as my mother knew of him in her own career as a speech pathologist. Stuttering is sometimes seen in SLI and so it is fitting that Tomblin is in that department. Here is something I wrote about this in connection to Standard American English:

“It’s interesting to note that many of the earliest speech centers and speech corrections/therapy schools in the US were in the Midwest, where many of the pioneers (e.g., Charles Van Riper) in the field came from—such as Michigan, Wisconsin, and Iowa. Right here in the town I live in, Iowa City, was one of the most influential programs and one of the main professors in that program was born in Iowa City, Dean Williams. As my mother audited one of Williams’ classes, she got to know him and he worked with my brother’s stuttering. Interestingly, Williams himself came in contact with the field because of his own childhood stuttering, when Wendell Johnson helped him. My mother heard Williams say that, while he was in the military during WWII, Johnson sent him speech journals as reading material which inspired him to enter the field when he returned after the war.”

I don’t know that Tomblin would have personally known or professionally worked with Williams. But surely Williams’ legacy would have been felt.

* * *

Specific language impairment
from Wikipedia

Specific language impairment (SLI) is diagnosed when a child’s language does not develop normally and the difficulties cannot be accounted for by generally slow development, physical abnormality of the speech apparatus, autism spectrum disorder, apraxia, acquired brain damage or hearing loss. […]

Specific language impairment (SLI) is diagnosed when a child has delayed or disordered language development for no apparent reason.[3] Usually the first indication of SLI is that the child is later than usual in starting to speak and subsequently is delayed in putting words together to form sentences. Spoken language may be immature. In many children with SLI, understanding of language, or receptive language, is also impaired, though this may not be obvious unless the child is given a formal assessment.[4]

Although difficulties with use and understanding of complex sentences are a common feature of SLI, the diagnostic criteria encompass a wide range of problems, and for some children other aspects of language are problematic (see below). In general, the term SLI is reserved for children whose language difficulties persist into school age, and so it would not be applied to toddlers who are late to start talking, most of whom catch up with their peer group after a late start.[5]

ADHD, Auditory Processing Disorder or Specific Language Impairment?
by Devon Barnes

SLI – Specific Language Impairment

Children with SLI are delayed and disordered in the development of their understanding (Receptive Language) and use of language (Expressive Language).

SLI is not due to cognitive deficits, sensory impairments or neurological problems.

Students with SLI can present with:

  • A history of delayed language development
  • Poor comprehension
  • Limited use of vocabulary
  • Poor grammar
  • Difficulty with sentence formulation
  • Word-finding difficulties
  • Poor pragmatic skills.
  • Children with language impairments can have excellent decoding skills but struggle with reading comprehension and so these difficulties can be missed in the early school years because they appear to be “good readers”.

In later years language weaknesses can negatively impact the student’s ability to cope with the learning demands of the curriculum as language underpins all learning.

They will have particular difficulty understanding grade related texts and with written language tasks such as assignments and essays.

Top 10 Things you should know . . .
about children with Specific Language Impairment

from The Merrill Advanced Studies Center, The University of Kansas

  1. Specific Language Impairment has many names and it is surprisingly common.
    SLI is just one of the many communication disorders that affect more than 1 million students in the public schools. If your child has been evaluated by a speech pathologist, you may have heard its other names: developmental language disorder, language delay or developmental dysphasia. Specific language impairment is the precise name that opens the door to research about how to help a child grow and learn.
    SLI is more common than you might think. Research over the past ten years has generated accurate estimates of the numbers of young children that are affected by SLI. We now know it could be as high as 7 to 8 percent of the children in kindergarten. In comparison, Down syndrome or autism affects less than one percent of the five-year olds.
  2. Late talking may be a sign of disability.
    As they enter their two’s and grow into three and four, children have a remarkable number of ways to tell adults what they need. Even if the words don’t all sound right, a normally developing child will make many efforts to communicate and will make his point effectively. Young children ask so many questions — often exhausting their parents and care providers. Children who don’t ask questions or tell adults what they want may have a communication disorder.​
    Children with SLI may not produce any words until they are nearly two years old. At age three, they may talk, but can’t be understood. As they grow, they will struggle to learn new words, make conversation and sound coherent. Today, research is underway to determine which children do not outgrow this pattern of delayed speech. By age 4 to 5 years, SLI could be a signpost of a lasting disability that persists throughout the school years.​
  3. A child with SLI does not have a low IQ or poor hearing.
    Several other disabilities involve difficulties communicating, but for these children the primary diagnosis will be mental retardation, or autism, or hearing loss, or cerebral palsy. A child with SLI scores within the normal range for nonverbal intelligence. Hearing loss is not present. Emerging motor skills, social-emotional development and the child’s neurological profile are all normal. The only setback is with language. SLI is the primary diagnosis.
  4. Speech impediments are different from language disorders.​
    A child with a speech disorder makes errors in pronouncing words, or may stutter. Recent studies find that most children with SLI do not have a speech disorder. SLI is a language disorder. This means that the child has difficulty understanding and using words in sentences. Both receptive and expressive skills are typically affected.
  5. An incomplete understanding of verbs is an indicator of SLI.
    Five-year old children with SLI sound about two years younger than they are. Listen to the way a child uses verbs. Typical errors include dropping the -s off present tense verbs and asking questions without the usual “be” or “do” verbs. For example, instead of saying “She rides the horse” the child will say “She ride the horse.” Instead of saying “Does he like me?” the child will ask “He like me?” Children with SLI also have trouble communicating that an action is complete because they drop the past tense ending from verbs. They say, “She walk to my house yesterday” instead of “she walked to my house.”
  6. Reading and learning will be affected by SLI.
    SLI does affect a child’s academic success, especially if left untreated. Forty to seventy-five percent of the children have problems learning to read.

How Children With Specific Language Impairment View Social Situations: An Eye Tracking Study
by Mariko Hosozawa, Kyoko Tanaka, Toshiaki Shimizu, Tamami Nakano, and Shigeru Kitazawa

RESULTS: The SLI [Specific Language Impairment] and TD [Typically Developing] groups each formed a cluster near the center of the multidimensional scaling plane, whereas the ASD [Autism Spectrum Disorders] group was distributed around the periphery. Frame-by-frame analyses showed that children with SLI and TD children viewed faces in a manner consistent with the story line, but children with ASD devoted less attention to faces and social interactions. During speech scenes, children with SLI were significantly more fixated on the mouth, whereas TD children viewed the eyes and the mouth.

CONCLUSIONS: Children with SLI viewed social situations in ways similar to those of TD children but different from those of children with ASD. However, children with SLI concentrated on the speaker’s mouth, possibly to compensate for audiovisual processing deficits. Because eyes carry important information, this difference may influence the social development of children with SLI.

Autism’s hidden older brother – Specific Language Impairment
by Andrew Whitehouse

Still, SLI remains very much a “hidden disability” within the community – poorly understood and rarely discussed.

One reason for the lack of awareness about SLI is the very nature of the condition. Communication difficulties silence the biggest weapon for penetrating the public consciousness – advocacy. Add to this the fact that relatives of children with SLI often have communication difficulties themselves and the advocacy problem is exacerbated.

A second reason is SLI’s younger but more muscular brothers: developmental dyslexia and autism. The earliest descriptions of SLI date to the early 19th century, well before the first descriptions of developmental dyslexia (1887) and autism (1943). But, the intrigue of the symptoms associated with these latter conditions, in addition to the strong and numerous advocacy groups that support them, have facilitated increased research and greater public awareness.

A recent analysis of data from the National Institute of Health revealed that autism receives over 30 times more research funding than SLI, despite affecting five times fewer people.

Promising research areas

Perhaps the most promising area of research for SLI investigates the “specialization” of the brain’s two hemispheres. In the majority of people, the most crucial areas involved in language production are found in the left hemisphere. Brain imaging studies have found that children and adults with SLI are more likely to have these language areas in the right hemisphere.

But like the genetic investigation of SLI, considerably more research is needed to really understand the neurological differences that underpin this condition.

Another area of particular interest is short-term memory. A series of experiments in the early 1990s found that children with SLI have considerable difficulty in accurately repeating nonsense words, such as perplisteronk and scriflunaflisstrop.

The inability to memorise previously unheard “words” and repeat them accurately is one possible reason why children with SLI have difficulty growing their vocabulary and stringing words together in complex grammatical structures.

Long-term impacts

Language development is highly variable and many children have early difficulties that resolve by the time they enter school. But when language difficulties persist into the school years – as in the case of children with SLI – there are often considerable longer-term effects.

Children with SLI are less likely to complete secondary school, and are more likely to experience long periods of unemployment during adulthood. What’s more, individuals with SLI have greater difficulties forming close friendships and romantic relationships.

The impact on mental health is significant, and adults with SLI are at a disturbingly high risk (around 50%) for depressive and anxiety disorders.

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