WORK IN PROGRESS
Do selective processing skills at 2-3 predict language, social
communication and literacy at 10-11?
Evidence from a follow-up study of clinically referred children
Penny Roy & Shula Chiat
City University London
http://www.city.ac.uk/health/research/research
-areas/lcs/veps-very-early-processing-skills
Background
• First concerns about a child’s language
typically emerge when children reach 2-3
years
• Children up to 4 constitute a substantial
proportion of first referrals to speech and
language therapy
• Many late talkers and early referred children
catch up with peers within 1-2 years
(Bishop & Edmundson 1987; Dale et al 2003; Paul 1996; Rescorla,
Dahlsgaard & Roberts 2000; Whitehurst & Fishel 1994)
Key clinical questions
• Who will have transient delays that will
resolve?
• Who will go on to have longer-term problems?
• What will be the nature of those problems…
– Difficulties with language?
– Difficulties with literacy?
– Difficulties with social communication?
– A combination of these?
Previous follow-up studies…
• aim to determine extent to which performance on
language, or speech and language, predicts later
performance
• are not underpinned by any particular theoretical
analyses of relations between early language and
language outcome
In contrast to previous follow-up studies, our research
was motivated by specific hypotheses stemming from the
‘mapping theory’ of language development…
(Chiat 2001; Chiat & Roy 2008; Roy & Chiat 2008)
Broad hypothesis
• Limitations in the basic processing skills
that underpin language
– may be informative about the nature of early
language delay or difficulties
– provide better predictors of later language and
communication disorders
Profiles of early processing skills may therefore
provide evidence to guide decisions on targeting
early intervention
Which skills?
We focused on two sets of very early
processing skills (VEPS) – phonological and
sociocognitive – as prerequisites for normal
language and communication
These skills are known to:
– develop in early infancy
– play a key role in language development
– be impaired in children with deficits in language
and communication
Phonological hypothesis
Early phonological skills will predict later difficulties with
morphosyntax
• Children’s ability to segment and recognise phonological
chunks within the stream of speech is crucial for
– acquiring words
– establishing syntactic structures
• A raft of research has revealed difficulties with nonword
repetition in school-age children with SLI
• Nonword repetition relies on phonological processing and
memory and has been proposed as a marker for SLI
(Bishop, North & Donlan 1996; Conti-Ramsden et al 2001; Gathercole 2006)
Preschool Repetition Test (PSRep)
We developed a word-nonword
repetition task for preschool
children as our predictor
measure of early phonological
processing
36 items of 1-3 syllables:
• 18 words
• 18 nonwords
(Seeff-Gabriel, Chiat & Roy 2008)
Preschool Repetition Test (PSRep)
Preschool Repetition Test (PSRep)
Sociocognitive hypothesis
Early sociognitive skills will predict later difficulties with
social communication
• A range of sociocognitive skills emerge at 8-15 months
• These skills are necessary for understanding meaning
intentions and discovering the meanings of words
• A raft of research has revealed relations between
deficits in sociocognitive skills and language in children
with autism
(Baldwin 1995; Carpenter et al 1998; Charman et al 2003, 2005; Sigman & Ruskin 1999;
Tomasello 1995; Tomasello, Strosberg & Akhtar 1990; Toth et al 2006)
Early Sociocognitive Battery (ESB)
We developed a battery of three tests as our predictor
measure of sociocognition
• Social responsiveness
Measures children’s responsiveness to expression of
feelings by an adult
(based on Sigman, Kasari, Kwon & Yirmiya 1992)
• Joint attention
Measures gaze alternation, gaze following and point
following
• Symbolic comprehension
Measures children’s understanding of gestures,
miniatures, and substitute objects used to stand for
another object
(based on Tomasello, Striano & Rochat 1999)
Joint attention
Joint attention
Symbolic comprehension
Very Early Processing Skills
– the VEPS project
Participants
• Referred to clinical services
with concerns about
language (not speech) at 2-3
• English first language
• No identified hearing loss or
developmental disorders
including ASD
Time points and sample sizes
of VEPS study
Time 1(T1) 209 children aged 2;6-3;6
VEPS measures administered
Time 2 (T2) 187 children aged 4;0-5;0
168 met our criteria
Time 3 (T3) 112 children aged 10;0-11;0
108 met our criteria
VEPS profiles at T1
50
40
30
20
10
0
both low
PSRep low
ESB low
both OK
PLS profiles at T1
taking a cut-off of -1SD
50
40
30
20
10
0
both low
expressive auditory low
low
both OK
Findings at time 2
• T1 receptive language (Auditory PLS) was the best
all-round predictor of T2 language outcomes
But for specific outcomes VEPS measures were best:
• T1 phonology (PSRep) was the best predictor of T2
morphosyntax (function word score on sentence
imitation test)
• T1 sociocognition (ESB) was the best predictor of
T2 social communication
(Chiat & Roy 2008; Roy & Chiat 2008)
T3 outcome measures
Receptive language
CELF receptive subscales
Morphosyntax
Novel tasks: Sentence imitation,
Grammatical judgement, Past
tense elicitation
Literacy
Test of Word Reading Efficiency
York Assessment of Reading
BAS Spelling subscale
Phonology and
morphology
Children’s Nonword Rep Test
(CNRep)
Social
Communication
Social Responsiveness Scales
(SRS) indicative of ASD
Proportion of T3 sample with average
performance at all time points
• T1: 34.9% had language in
the average range
• By T2 this had increased
to 53.3%
• At T3
– 62.3% had just
language in the
average range
– A similar proportion
(60.4%) had both
language and literacy in
the average range
100
80
60
40
20
0
Time points
T1
T2
T3
Profile of T3 social communication
according to SRS
• Just under a third of
the children were
rated by parents with
mild/moderate or
severe problems in
social communication
according to total
scores on the SRS
100
80
60
40
20
0
SRS
• Just under half of
these children had no
language problems
severe
mild/moderate
normal
Predictiveness of T1 measures (single and
combined) for T3 outcomes
T3
outcome
T1 predictors
PLS auditory
Sociocognitive
PSRep
Σ model
Morphosyntax
22.6%***
19.6%**
9.8%*
26.6%***
Literacy
25.3%***
23.8%***
17%***
33.4%***
Receptive
17.9%***
15.2%**
1.2% ns
23.5%***
9.8%**
8.1%*
23.6%***
26.2%***
21.3%***
30.5%***
2.8% ns
36.7%***
CNRep
SRS
From group level to case level
How do our predictors fare at case level in terms
of:
Sensitivity: Proportion of children at T3 who were
correctly identified as being low
Specificity: Proportion of children at T3 who were
correctly identified as being average
Likelihood ratios: Increased probability of having
or not having a problem
???
Prediction of T3 social communication
In line with the sociocognitive hypothesis, our T1
sociocognitive measure does best overall, coming
out just ahead of T1 receptive language:
T1
T3 Social Responsiveness Scales
Sensitivity Specificity
LR+
LR-
Sociocognition
0.57
0.89
5.31
0.48
Auditory PLS
0.39
0.91
4.12
0.68
But surprisingly, T1 sociocognition is a relatively
good predictor of all outcome measures, doing
as well as T1 receptive language…
Prediction of T3 receptive language
T1
T3 Receptive CELF
Sensitivity Specificity
LR+
LR-
Sociocognition
0.42
0.81
2.27
0.71
Auditory PLS
0.31
0.85
2.1
0.81
Prediction of T3 morphosyntax
Most surprisingly, and contrary to the
phonological hypothesis
•Sociocognition does relatively well on
morphosyntax
•In some respects better than T1 phonology
T1
T3 Morphosyntax
Sensitivity Specificity
LR+
LR-
Sociocognition
0.57
0.82
3.13
0.53
PSRep
0.74
0.54
1.61
0.48
Prediction of T3 morphosyntax
• But PSRep has a lopsided strength
• It achieves high sensitivity, so misses few
children with problems
• But at the expense of gross over-identification
T1
T3 Morphosyntax
Sensitivity Specificity
LR+
LR-
Sociocognition
0.57
0.82
3.13
0.53
PSRep
0.74
0.54
1.61
0.48
Prediction of T3 morphosyntax
• Conversely, T1 expressive language achieves
highest specificity for morphosyntax
• But at the expense of under-identification
T1
T3 Morphosyntax
Sensitivity Specificity
LR+
LR-
Sociocognition
0.57
0.82
3.13
0.53
PSRep
0.74
0.54
1.61
0.48
Expressive PLS
0.35
0.94
5.64
0.70
Complementarity of measures
Prediction of morphosyntax outcome illustrates
the complementarity of measures:
• PSRep has strong sensitivity – few
morphosyntax problems missed
• Sociocognition has better specificity… though
Expressive PLS does better – few children
with good morphosyntax misdiagnosed
Similar complementarity occurs with literacy…
Prediction of T3 literacy
T1
T3 Literacy
Sensitivity Specificity
LR+
LR-
Sociocognition
0.54
0.82
3.03
0.56
Expressive PLS
.37
.95
7.69
.66
PSRep
0.79
0.56
1.8
0.37
Conclusions: Performance at T3
• About 40% were below the average range on
language and/or literacy
• Just under a third had social communication
problems – at risk of ASD
• Approximately half had no problems with
language, literacy or social communication
Conclusons: contribution of ESB
Early Sociocognitive Battery (ESB)
• Informative about strengths and
weaknesses in sociocognition in
children referred with concerns
about language
• Indicates the risk of difficulties with
social communication (with or
without language difficulties) in
children not diagnosed with ASD
in the early years
• By 10-11, surprisingly good allround predictor – on a par with
early receptive language
Conclusions: contribution of PSRep
Preschool Repetition Test
(PSRep)
• No longer predictive of
morphosyntax at 10-11 (as it
was at 4-5) but…
• Still achieves a high level of
sensitivity
• and is predictive of CNRep at
10-11
Conclusions: overall prediction
• All measures over-identify – in line with well established
rates of recovery
• But some differentiation between measures…
• Receptive language (Auditory PLS) remained the best
predictor of all-round outcome – but surprisingly rivalled by
our VEPS measure of sociocognition
• Sociocognition remained the strongest predictor of social
communication
• Phonology (PSRep) was no longer predictive of
morphosyntax, but was predictive of phonology/lexical
phonology (CNRep)
Conclusions: contribution of VEPS
VEPS measures together achieve a similar level
of all-round prediction to standard measures
and…
• provide more information about the nature of
difficulties
• are better predictors of specific outcomes –
particularly impairments in social communication
• provide key evidence to support clinical
observations and judgements in the early years
• may help to focus early years intervention
We would like to thank:
Our researchers:
Talia Barry
Sophie Edgington
Liz Elliman
Renia Kaperoni
Luisa Martinez
Louise Occomore
Joanna Piper
Mia Travlos
Sharonne Williams
Our participants: children, parents and schools
Our funders
RES-000-23-0019
RES-000-22-4093